← The Tamsen Show
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- [00:00]
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Welcome back to the Tamsen Show. Well, today I'm covering a topic that brings up so much shame for women. I'm talking about hair loss. And believe it or not, this one hits really close to home for me. My hair was my whole personality in my 30s and 40s, I was on television every day and I was getting it blown out, running hot tools through it, styling it, really relying on it. It was a huge part of how I felt, confident in how I showed up in the world. And then I hit perimenopause. Unbeknownst to me then I went through a divorce and my hair started breaking off badly. The ends were snapping, the texture totally changed, and literally the floor of my apartment was covered with my own hair. I eventually did the big chop, and with that, I lost just a lot of my confidence because it didn't feel like me. And I think it's because as women, we wrap so much of our identity into our hair. When it starts to change or thin or just fall out altogether. I understand. It can feel like you're losing a piece of yourself. And I know so many of you listening today are dealing with hair loss. You've written in about it, asked questions about it, whether it's from pregnancy or perimenopause, menopause, stress, illness or changes you don't fully understand yet. And maybe you don't wanna bring it up or don't know where to go to bring it up. And I get the shame that you're feeling right now. So listen to me when I say this. I want you to leave that shame here. In this episode, we're gonna let it go. Because today you're gonna get real answers that help you understand what's actually happening, the treatments that could work for you, and you're gonna learn how to take control of it starting today. My guest today is Dr. Michelle Henry. I've known Dr. Michelle for years and I am thrilled she agreed to join me for this conversation. She's a leading board certified dermatologist who runs a full spectrum medical hair loss clinic right here in New York City. And she treats hair loss every single day.
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And.
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A
And she understands both the science and also the emotional toll it takes on women. By the end of the conversation, you're going to have some clarity about why hair loss happens, what's worth your time, and what you can safely stop worrying about. Before we get started, though, I want to ask you for a quick favor. Wherever you're listening right now, if you could leave a quick review and tell me what's Bringing you back to the Tamsen show each week. It really, really helps. Not just me, but our entire team behind the scenes working every day to make this podcast happen. I love you guys and I appreciate it more than you know. Today's podcast is sponsored by Midi Health. So many women tell me the same thing. They finally speak up about brain fog, exhaustion or anxiety and they're brushed off or told it's just stress or age. That kind of dismissal makes you question your own body. MIDI changes that by offering expert insurance covered virtual care that actually understands midlife and treats women like they matter. Ready to feel your best and write your second act script? Visit joinmitty.comtamsin today to book your personalized insurance covered virtual visit. That's joinmitty.com Tamsen Midi the care women deserve. This is a Monday.com ad thesamemonday.com helping people worldwide, getting work done faster and better. The samemonday.com designed for every team and every industry. The samemonday.com with built in AI scaling your work from from day one. The same Monday.com that your team will actually love using the samemonday.com with an easy and intuitive setup. Go to Monday.com and try it for free. Yes, the same Monday.com okay, let's welcome Dr. Michelle Henry to the Tamson Show. Hello there.
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B
Hello. Thank you for having me.
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A
Oh, it's so nice to see you. It's been a long time.
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B
It has. It's wonderful to be here. You look amazing as always.
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Well, thank you.
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B
Back at you.
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A
You know, we were talking before the show and I said we were originally talking about we're going to do skin, we're going to do hair, we're going to do all this stuff. And I went, you know what, we're going to do hair today. Because that question keeps coming up over and over. You're one of the leading dermatologists in New York City, but you really, really focus on hair. Can you talk about why that has become such a big part of what you're doing now?
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B
You know, it's a big part of what I do because it's a huge part of women's lives. You know, when I say as a dermatologist, I often say I'm part dermatologist, I'm part psychologist. And I think, as you said, there's a lot of shame around hair. And some women will have another dermatologist but come to me for hair because they feel comfortable having that conversation. They feel comfortable showing what no one sees. You know, with women it's really complicated because a lot of the things that we use to conceal are acceptable. You know, for men, concealment is not as acceptable. You see all these jokes about A, B, C, D, E, all the tools they use to hide, but women, we can hide really well. So a lot of women are using, you know, wigs, weaves, extensions, whatever they can for decades. And it takes a lot of courage to come to my office, reveal themselves and have that conversation. And so, yeah, I never thought of it like that.
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A
I mean, you're right. They come to you and they can be completely raw with you and feel safe. So what is bringing a lot of women to your office these days? Are you seeing any difference? Are you seeing women open up more about this?
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B
I am, because I think while you said a lot of. It's been shrouded in secrecy and shame, conversations like this are opening their eyes to the. That there are things that we can do. And technology has gotten a lot better. You know, there's a lot of research and interest in hair loss, not just for men, but also for women, which has not always been the focus. And I think people realize that there might be a solution for me. So let's step up to the table and have the conversation.
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A
It's gotta be an emotional conversation, though. How does it start? Because, you know, when I think about it, and I was sharing this story with you, you know, I went through my divorce. I didn't know I was in Perimenopause at the time. And I have a lot of hair. There's no question I'm Lebanese and Italian. Like, I have this. It blobbed on my head. But when I started losing my hair, and I was losing it, like, you would brush it, and it would be in the brush and all over the floor. And my hair is, like, particularly thick, so you could. I mean, you can literally floss with it. But you. You know, I was seeing it everywhere, and it would. It was just thinning, thinning, thinning, and then breaking, just breaking, breaking to a point where you'd pull up a strand of my hair and you'd see it just split all the way, you know, in half. And so for me, that was emotional. But I know there are women going through so much worse than that. So those are very emotional conversations.
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B
It is. You know, if we look at our cult, like, so much of how a woman is defined as through her hair, you know, if we look at ancient literature even, we're talking about the beauty of her hair, her golden strands or whatever it might be.
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Her dark, beautiful hair.
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And so it's a big part of a woman's identity. It's her crown in many ways. And so when that is starting to become less of what she wants, she doesn't recognize herself. She doesn't feel as valuable. She shames herself for feeling so invested in it, although society has told her to be. You know, so it's this inner struggle on, like, I know I'm more than my hair, but sometimes I don't feel like it. And is that fair? What do I do? And so it's a very difficult conversation. And so I think. And you feel alone because you don't want to talk to people about it. And part of hair loss, it's not only something that a happens, it happens. You know, over 40 to 50% of women, especially when you get to that perimenopausal period, will have some sort of hair loss. So it's very, very common. But people feel alone, and they feel like it reflects a lack of responsibility, a poor diet, they're doing things incorrectly. And so there's just so much shame. And so women get to a point where they're like, shedding that, and they're like, I just want to be me. And if it means that I have to have a cropped haircut, I have to do whatever. I just want to be healthy. I don't want to feel comfortable in my skin. And that's when they show up to the table to have the conversation.
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A
I want to go back to what you said. 40 to 50% of women in perimenopause or menopause have hair loss. Is that losing hair altogether? Is it changing the texture, breaking off, or is it severe hair loss?
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Yeah. So when that statistic is specifically for hair loss, which is a loss of density, a loss in the density and caliber of the follicles. And the most common type of hair loss is female pattern hair loss, which is something that we inherit. So we inherit that sensitivity, that genetic predisposition, and then those hormonal changes that are inevitable really exacerbate that. And that's where we start to see it a lot more in that perimenopausal, menopausal period.
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A
So you brought up, you know, diet or what's happening inside of your body versus what we're actually doing to our hair. Can you distinguish between those two things? Because, you know, for me, I'm like, oh, I won't put so much heat on my hair. I don't really know that that would have made a big difference When I was talking about it.
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B
So in my office, I call hair loss, that loss of density, that loss of the caliber and thickness of your hair. And I call hair breakage, the difficulty to have retention. And so breakage is usually an outside job. It is heat, chemicals, dyes, improper products, you know, not having the appropriate moisture, protein balance, so that your hair is just not as resilient and resistant to all of those external factors. So that's an outside job. And then the inside job, that's going to be the female pattern hair loss. There are many types of hair loss, telogen effluvium, that a lot of women get after pregnancy, those hormonal shifts. There are a number of scarring, hair loss conditions that are a consequence of inflammation, kind of like autoimmune diseases. The body turns on the hairs, turns on the scalp, and so those are the inside jobs. So that's what I call hair loss. Just to make that, categorize it.
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So hair, that's hair loss.
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And then there's hair breakage.
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A
There's different medicines. There's also GLP1s now, and there's a lot of conversation about that. Can you talk about that in GLP1s with relation to. Is that actually something that happens with GLP1s?
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B
Yes. And it's not that the GLP1 medication class itself is causing hair loss. Those metabolic changes are causing the hair loss. And so it's something we call telogen effluvium. And so, as I tell my patients, while our hair. Telogen effluvium.
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A
Oh, gosh, why can't we have simple names?
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B
It makes us feel very smart in derm. That's why we have all these long names that are probably unnecessary. But as I tell my patients, you know, our hair is really important to us, but to our body, not so much. So whenever there is a stressor, our body will shed our hair in order to preserve that metabolic energy for more important tasks. Right.
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A
Wait, so we shed our hair? So we're not giving out that much energy and growing our hair.
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When there's a stressor, our hair will shed. So when there is a mental stressor or a psychological stressor, you know, we see a lot of hair loss with stress for divorces, jobs, grief, when a family member passes. And so I always explain it to my patients that, like, we feel like our hair is really important, but when there is a dramatic shift, it's one of the first things to go. And what's important about that is that our hair also tells us a lot about our, the state of our health because it is quite sensitive to those changes. You know, sometimes I can see that someone's not eating well, they're dieting aggressively, they're really stressed. And I can see that before they have blood changes or heart changes or, you know, so it really does kind of tattle on the state of our life. And that's a part of the reason why so many people are seeing it.
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A
Yeah. So I want to give women solutions wherever they are right now. If someone's listening and goes, yeah, I'm dealing with this, whether it's perimenopause or divorce or a medication or pregnancy. And there are solutions, though, in any of those categories. Is that right?
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B
Absolutely, absolutely. You know, sometimes the solution is time. Right. Time is important in many ways. Time for things like telogen, effluvium, sometimes it's self limiting. But I also say that timing is one of the best medications. So the best thing you could do for yourself is get the appropriate diagnosis early. The minute, the moment, the second you think you're having hair loss, talk to your dermatologist. Because we are much better at keeping the hair than bringing it back when it's too far gone. So when someone comes in, they've lost 70, 80% of their hair. I cry inside a little bit. I know I could do a lot. But I know if you came to me five years earlier, I could make you really happy.
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A
Okay, so what should you look like? What's too much and what's not? I mean, you know, you're looking in the drain, you're looking. And for me, it wasn't really what was happening in the drain. It was what was happening on the floor, walking around, or when I got, when I blew my hair out, it was just covered. But what would be a red flag or a cause for concern?
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B
One thing that I tell my patients to do is to do a hair count, right? And so, you know, not everyone loses 100 hairs a day. I know that I don't. But when you're approaching that or going beyond that, we know there's a problem. So I want you to count every hair that you lose in the day, in your brush, on your pillow, in the shower. And if that's approaching 100 hairs a day or more, that's when you're, we're concerned something is going on. So that's that number to look out for.
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Okay, that's good to know. I didn't even know that.
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So 100.
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More than 100 hairs a day. You should come and find Dr. Michelle.
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Exactly.
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When women come to you for hair loss, where do you start in the process? You said a lot of times your hair tattles on you, but where do you actually start? Start in terms of treating them.
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B
So first I do a clinical exam. So I look at the hair. Do I really see a reduction in the density? Am I seeing signs of inflammation? Is the scalp healthy? You know, if the scalp and the soil is not healthy, the hair is not going to be healthy. So I want to see, are there things there? Is there scale? Is there redness? Is there tenderness? Is there an odor there? What is going on that might lead me to think, hey, something's wrong with the hair, with the scalp. If I don't see that, then I look at the quality of the hair. I might do a gentle, a pull test to see what kind of hairs am I getting, how quick, how easily can I extract those hair. When I see the hairs that shed, are they telogen hairs? So those are those hairs that have the little white bulb? Those are hairs, yes.
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Is that bad?
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No, that just tells me that those are hairs that your body prepared to kick out. Okay, so if it prepared it to kick out, why is it preparing more of them to kick out? So we have different phases of hair growth. You know, we have. Our anagen is our growth phase. Our telogen phase is when it's preparing to fall out. And then catagen is when it's falling out.
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Catagen.
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Yeah. When it's like, you guys do have hard words. We do, we do.
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I need, like, acronyms. A healthy scalp look like. Because I've been noticing a lot of. I don't know what they're called. Like, you know, like, I have a scalp scrubber, right, for the shower. But then there's also, like, oh, we can come in and fix your scalp. Like, scrub your scalp with whatever product it is. I don't know what it is at the salon, but what's a healthy scalp look like? Hot take.
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I don't know how much we need to aggressively exfoliate our scalp if we're cleansing. Everyone's different, however, right? I subscribe to the school of being more gentle with the scalp in the same way that we're gentle with our facial skin. You know, we want to have some gentle exfoliation, but not too much because that can cause inflammation. So a lot of these places that come in, and we'll do aggressive exfoliation on the scalp. Unless you are using very heavy products, you're using, you know, other things. That might build up. That's not always necessary.
- [14:17]
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Yeah, they put a thing in your hair and then they show you the scalp and it looks really gross. And then you're like, oh, yes, do whatever it takes to get. Get rid of it. I think they like magnified it by a thousand or something.
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There's a little bit of marketing there. Right.
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But it's not. I was marketed to, Michelle. I was marketed to.
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It feels good to you. I always say if it's a moment of self care that you enjoy, go for it.
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But what about the scrubbers? Those plastic scrubbers, do you like those?
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You know, as long as it's not too aggressive. It's all about after you do it, the scalp shouldn't feel tender. It shouldn't feel uncomfortable. Same way when you wash your face. We don't want that squeaky clean feeling. Yeah, your scalp shouldn't feel that way either. Your scalp is an extension of your facial skin. So all those same rules apply. We want it clean, but we don't want it to dry. We don't want it feeling like squeaky and uncomfortable. All of those things apply.
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Is there a look to it that somebody could, like, you know, move their hair over and look at the scalp
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and see it themselves? Yeah, you shouldn't see a lot of scale on the scalp. You shouldn't have a lot of buildup on the scalp. You shouldn't see redness around the follicles. When you see that, that could be an indicator that you have an autoimmune condition. So something like lichen planus or lichen plano pilaris is what we call it on the hair. Another long word.
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Tell me what it is.
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Lichen plano pilaris. So it's an. It's an autoimmune condition where those immune cells attack the hair. And one of the things that we see is we see redness around the follicle. We see redness in scale, specifically, like cupping the follicle. And that's a classic finding. If you see that, we need to see you, we need you to come in.
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Does that mean you're going to. That you'll start losing those hairs or. Yeah, not healthy.
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Inflammation. Discomfort means pending hair loss. If your scalp hurts, it's coming.
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A
So should we be getting our blood work checked to figure out how we're doing with our hair?
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B
You know, it's hard because a lot of hair loss conditions don't have identifiable markers in the blood. However, most women have more than one reason for hair loss. So even if you have female pattern. I take blood work on every patient because I want to make sure that you're metabolically optimized, that your nutrition is optimal because again, our hair is so sensitive. So if any of those things are not quite right, you're likely going to lose hair. So we do do that just to optimize it, but there aren't a ton of things. Some of the markers I do look for, however, are your ana, which is a screening test for autoimmune conditions. I look at your prolactin. So I've identified a lot of women with actually tumors, prolactinomas. Because when the prolactin is elevated, that can affect your hair loss. I'm looking at your thyroid. That's important to check. Your iron is important, your B12 is important, your hormones. So I'm always looking for those hormones. A lot of women I've done found that they're going into menopause early, like in their 30s, because their hormones reflect that, hey, this is a 31 year old woman. But these are like, you know, late 50s hormones that are going on here. And so I always do blood work because, you know, it can, it can assist us in understanding in some cases.
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A
I mean, you're really seeing a lot in hair to help women identify what stage they're in of their hormone journey. So let's go back to some of the things that you mentioned. You mentioned vitamin B, right? And you also mentioned thyroid. And so when I hit menopause, thyroid change, cholesterol change, I had all these like crazy numbers, pre diabetic numbers. So if you have a woman that is going through perimenopause and said, yeah, my, my hair, I don't even, I, I don't even notice. I can't even, it's not my hair. This is not my hair anymore. It's dry, it's not feeling the same way. Those are all hormone related. Is that estrogen, progesterone, testosterone?
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Absolutely. So estrogen is, it's, it's a pro hair hormone, as is progesterone. Those are all pro hair. Not only are they pro hair, they're pro skin. And so part of why our skin gets drier in that perimenopausal, menopausal period is because we really need estrogen to help to create our ceramides, to help to create hyaluronic acid. That's also important on the scalp. And so not only is our skin getting dry, but our hair is getting dry. And so each hair follicle is attached to not an oil gland and other glands that are helping to coat it and make sure that it's appropriately hydrated. And when we lose that, our hair also suffers.
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A
So there's a lot of women that are trying to figure out right now whether or not hormone therapy is an option for them. Some it cannot be an option for them. Others said, yeah, I'll think about it. And others, you know, will opt to take hormone therapy. Somebody takes hormone therapy, can that be helpful for their hair?
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Absolutely, absolutely.
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Ahead of time, before they start experiencing hair loss or even if they have
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started experiencing it, even if they have started to experience it, it absolutely can help their hair.
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And then if they are not opting for hormone therapy or can't take it, there are other things.
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Yeah, we have a ton of other options. So if we're not looking to go a hormonal route, we have minoxidil. Minoxidil is not hormonal. It's the only topical FDA approved hair growth solution on the market. Some people can't tolerate that, but we use it topically, we use it orally. What's exciting is that there is a now a low dose extended release minoxidil that's due to hit the market. What's great about that is it's better tolerated, it's low dose. So less chin hair, which we're already struggling with, we don't need any more of that. Less chin hair, less body hair and a better safety profile. So oral minoxidil, while quite safe in a small portion of patients, it can put you at a higher risk for collecting fluid around the heart, which is not something we want to trade for hair. The lower dose doesn't do that. So we have minoxidil, we have PRP where we draw your blood, we take those platelets, we extract the growth factors from them and we inject them into the scalp. So harnessing the body's own capacity to grow hair, we do that. We have what we call recombinant platelet derived growth factors. So those growth factors also get a little wimpy as we get older. So now we can make the growth factors just like our own in the lab, microneedle them and get growth. So I love that. Or I can go all day.
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No, no, I want it all because I really want women to have these options because everyone's not going to opt for one thing or another. So if we go back to minoxidil for a second, because it does come up constantly, is the topical something you feel is safe for Women during. Or people during this time. And who's a candidate for the topical versus the oral.
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B
So I think it's extraordinarily safe topically. And I do. I compound varying strengths. So if I think someone is at risk of having side effects, I'll make a lower strength. So the highest strength over the counter is a 5%. That's marketed towards men. But I'll tell a lot of women, go ahead and use a 5%. It's absolutely safe for women. I will make it all the way up to 10% in my office.
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A
I can't wait till women get our own stuff.
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B
Right?
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Won't that be nice?
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B
It's coming. It's coming. But that's safe. And a lot of what we understand with minoxidil, which we've used it forever, we still are doing work to understand it completely, but we know that it dilates blood vessels, and so that allows more nutrients to the follicles, and that's how it helps to stimulate growth. It has kind of a regional effect. So not just where it touches, it really goes all over, which is why a lot of my patients love their brows get thicker. Oh, good. You can get chin hair, sideburn, hair that they don't want.
- [21:04]
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Oh, my gosh. Okay, I didn't know that. I didn't know that. But that's the science behind it, because it's working all over. It's not just working on your. On your scalp. Right.
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When you use it topically, orally, it's working everywhere. When you use it topically, it's regional, so we put it on our scalp, but it can work anywhere from the scalp to the chin.
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Should you get it prescribed or can you do that over the counter?
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You can do it over the counter. When we prescribe it, it's stronger, so it's often more effective. And when we prescribe the topical compound, I often mix it with other ingredients. I'll mix it with tretinoin, because that helps it penetrate. I'll mix it with finasteride, because that helps to block the conversion to the very strong male hormone that causes hair loss. I'll mix it with dutasteride, which is even stronger than that. I'll mix it with steroids. What we know from some studies is that women, for whatever reason, even in female pattern hair loss, we have more inflammation than men. And so I will add a little bit of steroid to help with that inflammation, which is inevitably also affecting hair.
- [22:00]
A
This show is sponsored by MIDI Health. I remember it sitting in the doctor's Office listing off everything I was feeling. Exhaustion, brain fog, mood swings, sleep, all of it. And getting nothing but a vague smile. And this is just part of getting older. No test, no plan, just a brush off. And I thought, is this really it? If you're in midlife and feeling dismissed or unheard, I want you to know you're not imagining it. And you're definitely not alone. 75% of women who seek care for perimenopause or menopause symptoms, they walk away untreated. That is outrageous to me. And it's why I'm so grateful. Mitty exists. MIDI is a virtual clinic built specifically for women in midlife by experts who actually get it. They're the only women's telehealth platform covered by major insurance. So it's not just high quality, it's accessible. What I love most, their clinicians listen one on one, face to face. They take the time to understand what you need and create a plan that works. This is the care we have been waiting for. Go to joinmini.com tamsin and finally feel seen. Ready to feel your best and write your second act script. Visit joinmitty.comtamsintoday to book your personalized insurance covered visit. That's joinmitty.comtamsen Midi the care Women deserve here's something most people don't realize. If your computer feels slow, if it overheats after you open up a few tabs, or it sounds like it's about to take off, the problem isn't the device, it's the antivirus software running in the background. I know. That shocked me too. A lot of traditional programs are heavy. They take up space, they constantly scan, they throw those pop ups everywhere and they drag everything down. Webroot is cloud based antivirus engineered to stay out of your way. It takes up 33 times less space than those bulky competitors and scans six times faster. So you really get powerful protection without the lag. The intelligence lives in the cloud where it should be and keeps your computer running light. I switched because I was tired of protection. That meant everything was slower. It runs quietly. No drama. It just works. And TAM fam. In a world where scams are getting smarter by the day, that really matters to me. For a limited time, you can save 60% on Webroot when you go to webroot.com Tamsen that's 60% off today, but only when you go to webroot.commentsen now when you start it, I know that you can start to lose hair. Initially when you start. Is that correct? And why does that happen?
- [24:31]
B
Because in order for a new hair to come in, an old hair has to go out, right? So we have those different phases. And it can be a scary moment because you're losing hair. But I often tell my patients you're losing hair because you're a great responder. That means there's a new hair that is likely programmed to live longer, that's pushing that old hair out. So it's a normal part of it.
- [24:50]
A
That's a normal part of things. And don't panic if that's what's happening.
- [24:53]
B
Try not to panic.
- [24:54]
A
Try not to panic. What happens if you stop using the product? Have you started the growth or do you have to continue to use it to continue to have results?
- [25:01]
B
That's an excellent question, because I have so many women that refuse to start it because they feel like I'm going to have to use it forever. The truth is, anything that works in female pattern hair loss you will likely have to use for a long time because we don't have a cure for female pattern hair loss. Whatever you're using, if you stop it, you're going to lose some of that hair. That's if it's female pattern hair loss. Now, if you've lost your hair as a consequence to pulling it or dyeing it or damaging it, you will keep that hair. Because it all depends on the process and the mechanism for loss. If the process, mechanism, disease can go away, you keep the hair. If it can't, you have to keep using it for a long time.
- [25:36]
A
You're with those people for a long time and that's okay.
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B
We're family now.
- [25:39]
A
You talked a lot about marketing and we know there's a lot of marketing out there. Is there a shampoo that you think is particularly good for hair loss to help?
- [25:46]
B
There are a lot of shampoos that I think are particularly great for hair retention. Because if you think of a shampoo, a shampoo is on for a few minutes and washed off. It's a short contact agent, right? And so the most more potent tools that are to stimulate hair growth are going to growth, are going to be leave on products. So I think a shampoo's main role is to get rid of those things that are compromising the scalp. So making the scalp very clean, getting rid of inflammation in the best ways that it can also, you know, not damaging the hair. So having the right surfactants or leaving the hair healthy and moisturized and like pliable, not stiff, that I think that's the biggest role. And so that does help with growth because it's retention. But in terms of stimulating growth, shampoos are my first place that I go to.
- [26:32]
A
Hair supplements. What do you think about that? I know there's a lot of supplements in the market right now that say they're helpful for hair growth, maybe for retention as well, to just have healthier strands of hair. How do you feel about the supplementation?
- [26:44]
B
You know, I am a fan of some of them, and that's an excellent segue because I often tell my patients I think of shampoos as like a topical hair supplement. So what a lot of supplements do is while they may not stimulate hair growth, they create an environment that's optimal for growth. So shampoos are doing that as well. All right, so we're making sure that we're replacing any nutrients that you're missing, right? That we are. There are some that have ingredients, like saw palmetto, for instance, which is a. It's a natural low potency DHT blocker. Right. So it may reduce hair loss. So it's creating an environment that's ideal for hair growth.
- [27:20]
A
Is there any on the market right now that you want to name that makes sense for you?
- [27:24]
B
The ones that I recommend in my office, I do recommend Nutrafol. You know, my first practice helped with some of those studies, so I felt like they were appropriate. I do recommend Viviscal. I think that's a good one. Those are two that I've seen a lot of results in my office. There's another called Biosil, which is more. Biosil. Biosil. It's not as popular here, but I lecture a lot in Europe as well. It's more popular in Europe, and so it has a lot of the amino acids and building blocks that we really need for the hair. So those are probably the three that I recommend the most.
- [27:55]
A
Okay. Yeah. I think it's just important that people know, just because I see so many things. I mean, I've never seen so many products out on the market, so to at least be able to drill down a little bit. This is a topic I don't know how to talk about yet, but peptides. I hear a lot of conversation about peptides. I'm not exactly sure I know what they are, and I'm not exactly sure I know whether or not they belong in the hair conversation. But do they?
- [28:16]
B
Yes. And I think it's an area of active research, and I think it's going to become a more meaningful conversation in the future. You know, there are a lot of products that are ingredients or peptides that are not quite commercial products yet that are being looked at in the lab for efficacy. So what I like about peptides in general, whether it's hair care or skin care, is that we want to get these ingredients into the skin. But the skin first and foremost is a barrier. So just getting products to absorb into the skin is not the easiest task. Right. So what peptides do, I always say it's like this little Houdini trick. They sneak their way into the skin and then they create this big molecule. So it's a great way to stimulate the molecules that we really need, and that's why they use it in skincare. And as I said, the scalp is just an extension of the skin. So if the scalp is healthy, it's going to produce healthier hairs. So you're seeing some of those molecules, like copper peptides, we're starting to see more and more in hair care. And what are those peptides doing? A. They're somewhat anti inflammatory, they're helping to stimulate collagen. So you have a more robust, healthy, functional scalp. There are some studies saying that they may actually reduce the effects of some of those androgens, those strong male hormones that cause hair loss. We're starting to see some that research labs are looking at that are supporting what we call the WNT pathway. And so the WNT pathway is really important for the creation of follicles. So the creation and kind of of propagation of follicular growth and hair growth. And so that's a really powerful pathway. And so these new peptides that are kind of pushing that, I think if we, if they fine tune it appropriately, could really be a game changer in the hair loss community.
- [29:54]
A
How do you take those or how
- [29:55]
B
are they administered right now? Because it's still more research based. They're injecting them.
- [30:00]
A
Okay, so you would inject them in your scalp?
- [30:02]
B
Yeah. Oh, wow.
- [30:03]
A
Okay. And then. All right, that's interesting because I keep hearing about them in all these different areas and I'm never. I'm never quite sure, you know, so we talked about perimenopause and menopause, and I want to go back one second. You know, pregnancy. And when women are dealing with breakage or hair loss in pregnancy, is that treated the same way that you would treat it in perimenopause or menopausal women?
- [30:22]
B
Pregnancy is typically a pro growth period because estrogen is the hair hormone. Right. So women are excited, they love their hair. You know, they're maybe complaining about Lots of the other changes, but hair is typically not one of the changes that they're complaining about, but that period when the complaints start are, you know, post delivery. So that postpartum period, about three months postpartum, when we get those hormonal shifts, we start to shed those hairs that benefited from that pro estrogen state. I see. And that's when it can get really tough. And, you know, it's very hard to treat because especially if a woman is breastfeeding, a lot of the treatments that I would typically give you, I can't give you.
- [31:00]
A
Yeah.
- [31:00]
B
And so a little bit of what I do in my office in that period, we'll give supplements that we find to be okay. Always talking to their gynecologist or OB and their pediatrician to make sure they're aligned. I will do things like PRP because it's more natural. It's harnessing your body's ability.
- [31:15]
A
And what's prp?
- [31:16]
B
Platelet derived plasma plating from your own body. Exactly. So taking from your body, injecting that into scalp. We're actually right now doing a trial on a laser called the Folix. And what the Folix does, it's just resurfacing. So it's just energy, nothing that you absorb. But when we create little micro trauma on the scalp, what does the body do? It heals. And in that healing process, it's pushing out all those good, yummy growth factors that we need for restoration. And so we will do laser treatments on the hair and patients as well.
- [31:44]
A
I feel like there's a lot to be encouraged about right now with everything we're seeing. Yeah, there is.
- [31:49]
B
You know, it's a patience game with hair. There's a lot we can do. And if you can have the patience, the commitment, and the consistency, for the most part, we can make it better.
- [31:58]
A
Is red light any part of hair?
- [32:00]
B
Absolutely. You know, I look at red light as an adjunct to everything else. So is it going to reverse your hair loss on its own? Absolutely not. But as we've discussed, maintenance is a huge part of maintaining your hair. And so red light helps to stimulate those mitochondria, which are kind of like the powerhouse part of our cells. And that kind of gets everything working. We need that energy to make things happen. And so that's how red light works. And I find red light, we call it photobiology, really fascinating, you know, and so it is something that I recommend in my office. It's something we do in the office. And there are better and better red light Devices on the market, and because they've become so popular, there's more and more research around. So it's something that, you know, do you need to spend $10,000 on it? Probably not, because it's not going to cure your hair loss. But if it's a device that you enjoy using, I think that it can help.
- [32:47]
A
All right, let me go back to some old school stuff. Massaging the scalp, brushing, I don't know, 100 times a day. I've never done any of those things. Do any of those things matter?
- [32:55]
B
There are things that I typically recommend. It's very romantic, and I think of, like, Victorian movies and some beautiful woman brushing her daddy hat. We don't have time for. We have teenagers, TV and social media. Right, okay, so no one's doing that. But, you know, we actually don't want to overly manipulate the hair. So I don't recommend brushing 100 times a day. That's over manipulation and could lead to breakage and damage. Massaging the scalp, as long as it's gentle, is fine. It's likely gonna get off dirt and debris. Is it giving you enough blood stimulation to get growth? You know, it's hard for me as a dermatologist to say it. We don't have data supporting it. You know, if you enjoy it and it's not gentle, I will slap your hand about it. But. But aggressive massage is not something we necessarily need.
- [33:32]
A
Let's talk about holistic care and nutrition, because I feel like everything always comes back to that. Because at the end of the day, no matter what in office treatments you're doing, you still have to go home and do something the other 364 days a year. Right. So where does nutrition and lifestyle fit in to help support hair growth?
- [33:48]
B
Yeah, it's really important. As with all things trash in, trash out, so if you're not giving yourself the nutrients that we need for all of our enzymatic pathways to work, all of our growth pathways to be optimized to get those amino acids from the protein, to have the factors we need to get hair growth, you're gonna see
- [34:06]
A
that in your hair.
- [34:06]
B
If you have a poor diet, you're gonna see that in your hair. If you're too stressed and not doing your best to manage your mental wellness. Right. You're gonna see that in your hair. So diet is important. Things like lean proteins, healthy fats, avocado, salmon, flaxseed, all of those things are gonna give you those healthy fats, those fatty acids, those omega 3s that lean protein, all of that's going to support healthy hair growth.
- [34:30]
A
Is it the protein and omegas that are the most important for this time?
- [34:34]
B
Yeah, those are going to be the most important because our hair is literally made of those amino acids and those structures, so protein is really critical.
- [34:41]
A
Is there anything you're seeing women do right now? Because I think we're in this era of trying anything and everything that's actually making hair loss worse.
- [34:50]
B
I think we're in an era where we're having a lot of fun with our hair. You know, we are, you know, trying a lot of things or weighing fabulous, like, you know, wigs, extensions, all of those things which are beautiful and gorgeous. And I'm a victim of too.
- [35:03]
A
Right.
- [35:04]
B
Like, it's. It's great. But we need to realize that our hair is really delicate and our hair is not plucked and, you know, carry such weight. And I think while we're having fun, we need to give our hair breaks. You know, we need to not lose hair care and hair beautification. So we need to make sure that while we're beautifying our hair, we're still taking care of it as well.
- [35:23]
A
So what advice do you have for somebody that is doing extensions or doing weaves or wearing wigs and touching and tugging and pulling on hair all the time? Because at the same, it's a balance, right?
- [35:35]
B
You know, it's a cycle you need to have on and off times. You know, you need to give yourself breaks. You know, you need to have those days where you're doing, like, appropriate treatments on your hair. You're checking in with your hairstylist and your dermatologist to make sure there's not damage that you're missing. It's just about checking in with your. And again, not losing the hair care part of hair beautification and hair styling.
- [35:56]
A
All right, let's go to the probably most emotional conversation that you have. If a lot of these treatments are not working and we're talking about hair transplants or we're talking about something a little bit more serious, a little more next level. What is that next level? If nothing's working and somebody says, but I still want this, then we do
- [36:16]
B
determine if you're a candidate for hair transplantation. And once upon a time, hair transplantation wasn't something we thought of for women. It was really just for men. And some of that is because our hair loss patterns are a little bit different. But I will say 90% of my hair transplant patients are women. And so that's another part of why timing is so important because we don't have an inexhaustible amount of follicles. You know, when we're doing a hair transplant, we're literally just shifting follicles around. And if you don't have enough follicles to shift around, you're just not a candidate. So you want to come in before your hair loss is too gone, right? Too far gone.
- [36:48]
A
So you start seeing that 100 and you get to you, or get to somebody that can treat you and see where you are.
- [36:55]
B
Let us manage it and let us stabilize you. Because we need to stabilize you before we start talking about hair transplant, right? We want to see where you land. We don't want to shift all the hairs from the back just for you to lose them. And we've now just shifted your hair loss. So we want to stabilize you first, see where you sit, right? Control the medical hair loss and then do the aesthetic portion of shifting those hairs around so to conceal in an appropriate way.
- [37:18]
A
So a candidate, a good candidate is somebody who has been stabilized, who's been
- [37:21]
B
stabilized and has a good, what we call donor site. So the recipient site is the bald area that we. Or the thinning area. The donor site is the hair that we're usually taking from the back to put into the front. So we want to stabilize you.
- [37:32]
A
Who should not be getting a hair transplant or who's not a good candidate for that?
- [37:35]
B
Someone who's not a good candidate is someone who has uncontrolled medical hair loss. So I have a lot of patients that have, let's say there's a condition called ccca, which is a scarring hair loss, central centrifugal, cicatricial, those long words, you know, someone who's not controlled. And they, they say, you know what, hair transplants are $1,500 in Turkey. I'm gonna get one. And they're gonna do it right, because it's a, you know, it's an elective procedure. But you come back and you're still losing the hair. And now you have these tufts of implanted hair, but you're losing hair everywhere else. You didn't get the aesthetic result that you want. You did not get a long term result. So someone who has not medically managed their hair loss is not a good candidate. Someone who just doesn't have enough hair follicles because you don't want to invest your money and just create baldness elsewhere. Again, it's not an inexhaustible source. You're not taking it from somewhere else. So you really need to go to someone who is ethical, who knows what they're doing and can give you realistic expectations.
- [38:29]
A
Yeah. Because that has to be double emotionally traumatizing. Really.
- [38:33]
B
I just had a patient just like that, went to Turkey. I hadn't seen them for a year. Then they came back in. They're like, I have the transplant, but I'm still losing my hair because they weren't consulted correctly.
- [38:43]
A
What do you want women to do? To stop blaming themselves? Do you feel like women blame themselves
- [38:47]
B
for this entirely too much? You know, women tend to be, you know, I don't want to do gender wars here, but women tend to be more self reflective, you know, and I think culturally we're trained to blame ourselves. Right. We're fixers. Right. And in trying to fix, you control what you can, which is yourself. Right. And so you blame yourself for all these things that you had zero control around. So I think what we can do is a stop blaming ourselves. Share our stories. I think I always say as a dermatologist, I'm always open to share my stories because I see everyone else's. I know that, like, we all have our good, we all have our bad. It's a part of the human experience. So talk to your friends, know that you're not alone. Seek out information, advocate for yourself. You know, we all get mad when patients say, do your own research, but do your own research. It's important. Understand the space, have the language for yourself. That's all a part of advocacy, advocating for yourself. Right. And also in the process of regaining your hair. Also know that you're not just your hair. You know, not all of us can fix it. But know that women are so much more than our external. While you want to do the work, you want to be your healthiest self. You know, understand that we're dynamic, amazing beings that are more than our external appearance.
- [39:53]
A
I think people needed to hear you say that because I think it's so important and I know it's easier said than done, but I think opening up these conversations because the truth is, until you're dealing with it head on, I don't even know if you're thinking about who you would talk to about that. So it's nice to know that a dermatologist is that your first stop.
- [40:10]
B
Where you do dermatologist is absolutely your first stop. We are the hair, nail and skin experts and it's important because we're doing more than just diagnosing, we're also treating. Right. So it doesn't matter if you just get the diagnosis, but you can't do the treatment. You want someone who understands this, who does this a lot, who understands. You know, I treat a lot of hair loss and they're all just a little bit different. And at this point, years and years and years of doing it, I know that although it's the same diagnosis, this person's gonna benefit a little bit more from this treatment. This hair type needs, this type of shampoo. This hair type, you know, this personality type is gonna do better with oral medication than topical medication. So we're treating the hair, but we're treating the person. And if someone's not doing that, they're not giving you the ideal package treatment journey for your disease state.
- [40:56]
A
Okay, I want to take a second and talk about something that really, really surprised me and honestly changed how I think about something as basic as water. Three out of four US Homes have toxic chemicals in their tap water. I know even when it looks clear, it can still contain things linked to fatigue, hormone disruption, brain fog, and long term health risks. I assume my fridge filter had it covered. Apparently it doesn't. And bottled water comes with its own issues. Microplastics. That's why I started using Aqua True. Aqua Tru is a countertop water purifier that removes 84 contaminants, including chlorine, lead, forever chemicals and microplastics. It uses a four stage reverse osmosis system that goes far beyond filters. No plumbing, no installation, just clean water that I actually trust. Aquatru has been featured in Business Insider, Popular Science and was also named best countertop water filter by good housekeeping. And 98% of customers say their water is cleaner, safer and healthier. Go to aquatrue.com now for 20% off your purifier using promo code Tamsen. Aqua Tru even comes with a 30 day best tasting water guarantee. That's aquatrue.com A Q U A T R U.com promo code T-A-M-S-E-N. I don't know about you, but good hair days for me change how I
- [42:14]
B
move through the world.
- [42:15]
A
When my hair feels healthy, I'm not thinking about it all day long. I'm not like adjusting it or changing it or trying to fix it. It's one less thing that's asking for my attention. And that ease matters to me, especially on busy days. That's why Nutrafol stands out. It takes a proactive approach to hair health by targeting root causes that can contribute to hair thinning and shedding, rather than chasing all the quick fixes out there, their formulas are clinically tested, peer reviewed and dermatologists recommended. And it's why so many people turn to Nutrafol when they want something grounded in science and not hype. And I am all about the science.
- [42:49]
B
What I really appreciate though is Nutrafol
- [42:51]
A
isn't a one size fits all. There are different formulas designed for different life changes and lifestyles, including options for menopause and plant based diets, so the support actually fits where you are. It's designed to work over time, supporting improved hair growth, visible thickness and overall hair quality while keeping things simple and consistent. Nutrafol is the 1 dermatologist recommended hair growth supplement brand and the number one hair growth supplement brand personally used by dermatologists. Let your hair be one less thing to worry about. See visibly thicker, stronger, faster. Growing hair in three to six months with Nutrafol. For a limited time, Nutrafol is offering our listeners $10 off your first month subscription and free shipping when you visit nutrafol.com and enter promo code TAMSEN10. That's nutrafol.com spelled N U T R A F O L.com promo code TAMSEN10. If somebody is listening right now and feeling embarrassed or not sure what to do or shameful, what do you want them to do? What's the first thing to do to to tackle this?
- [43:57]
B
Shed all shame. You know, this is not your fault. And even if you feel like it is because you died, you did this, it's not. This is a part of the human experience. Again, over 40%, 50% of women will deal with hair loss. So you're not alone in this. Seek out help and be honest. Be honest about what you're doing. I think a lot of patients come in, they don't really want to tell you what they did because they're ashamed. Have no shame. We have seen absolutely everything. There's nothing a patient's gonna come in to do and surprise me, right?
- [44:26]
A
Dr. Michelle is unshockable.
- [44:28]
B
I'm unshockable. I've seen all of the things. So come in. Understand that it's a journey. Come in. Ready to have a long conversation to share. All cry if you need to. You know, we'll hold your hand. Prepare for the journey. It's a journey. Have patience and know that it's just one part of caring for yourself. You know, we do enough work. Take this moment to care for yourself.
- [44:47]
A
We're gonna do a quick pass or keep because I feel like so much information comes at us right now that I never know what. You know, what's yes and what's no. So pass or keep. Prp, platelet rich plasma, keep. Laser caps, red light therapy, keep.
- [45:05]
B
But it's not like the holy grail, but keep.
- [45:08]
A
Okay, so we can keep those for a while. Yes. Oral minoxidil.
- [45:12]
B
Keep, if you're the right candidate.
- [45:14]
A
Topical minoxidil.
- [45:16]
B
Absolutely. Keep.
- [45:17]
A
Hair growth supplements, Keep.
- [45:19]
B
Depending on what other medications you're taking in your health state, you can't ask
- [45:23]
A
a doctor these because they always have to have it. There's something behind them.
- [45:25]
B
I know.
- [45:26]
A
No, it's good. I'm glad. I'm glad biotin don't keep.
- [45:31]
B
You know, biotin is something we've always recommended for hair, but the original studies on biotin were around nails, and we just assumed that, like, hair and nails are the same, but they're not. You know, we really don't have huge, robust studies on biotin. And actually we're starting to recommend it less and less. When I first started, we'd give patients 10,000 micrograms of biotin. We don't do that anymore because we know that very high doses of biotin, and this is important in that perimenopausal, menopausal period where we're at a higher risk for having heart attacks. If you have a heart attack and you have a lot of biotin in your blood, it makes it harder for them to read your cardiac enzymes. And so that puts you at tremendous risk. So I no longer give high doses of biotin. If you look at a lot of the hair supplements, a lot of them have less and less biotin than they used to. So lower doses of biotin. So biotin, I actually is not my number one go to anymore, so. So I could take or leave it more. Leave it.
- [46:23]
A
I think we leave it. I think we pass on that after what you said. Rosemary oil.
- [46:27]
B
Rosemary oil. You know, the studies on rosemary oil. Even to call it a study is too much. You know, that's what's happening with social media. People are looking at, quote studies. It's not a study if There are only 25 people. Yeah.
- [46:39]
A
What is a study? Let's define a study so we have some clarity on what's going on out there.
- [46:44]
B
So in medicine, you know, we grade quote studies based on the level of evidence. So the lowest evidence is gonna be something like an expert opinion. That feels humbling to say, but my opinion is just my opinion. No one's gonna change everything like my patients should, I hope, but we're not Gonna change protocol. If my opinion is different from what's the gold standard?
- [47:03]
A
Right.
- [47:04]
B
The next lowest level is gonna be a case report. Someone writing about, here's a patient, this is what happened, I'm giving you all the details. The next lowest is gonna be like a case, case series. Right. So these are 25 patients that did well. That's not enough to change.
- [47:19]
A
That's just a low amount.
- [47:20]
B
That's a low amount. That's not enough to change like the gold standard of medicine. So what changes the gold standard of medicine. So they're gonna be things like randomized controlled studies. So these are studies, we have thousands of people. Right. The, the treatments are blinded to the patients and the doctors. So we're gonna, we're extracting bias. Right. We're doing multiple sites because it's hard to get collusion. Right. When you have 10 different sites. So now that makes the data even better. And even bigger than that is going to be something that's like a meta analysis where they are looking at multiple of those randomized control studies, analyzing them and saying, okay, what's the data from this? So the more people, the larger the study, the more investment in reducing biases. That's what gives us the high level gold standard. Developing research.
- [48:05]
A
So we need to know what study means before we say study.
- [48:07]
B
Exactly. But we see on social media they're like, like there was a Rosemary study. I think that Rosemary study was 25 people. And it's more of like a proof of concept. Like it doesn't hurt. So I don't say don't do it. Right. It doesn't hurt. But if you're having a real hair loss condition, you're not just going to use rosemary oil and think it's going to. You're just wasting time.
- [48:23]
A
Okay, I like that, I like that, I like that you can cut through it all. Scalp oiling.
- [48:30]
B
You know, I hate to reject scalp oiling because I think there are things that are. Have such rich cultural ties. Right. You know, I think about like in the Caribbean, we use it a lot. I think about my South Asian patients with scalp boiling is just a big part of the culture. Do we have data to say that it stimulates hair growth? We don't have firm data. Right. But maybe it's contributing to hair retention. Maybe the stress reduce and the familial.
- [48:58]
A
I was going to say maybe it's
- [48:59]
B
exactly that we get from having these moments are making us overall healthy and happy. So I don't reject it. But I will say, you know, there are Certain oils that I stay away from. Things like olive oil, for instance. Olive oil?
- [49:11]
A
Really?
- [49:11]
B
Yeah. Olive oil is what we use to grow certain yeast and like fungus in the lab. So there's some. There's some.
- [49:18]
A
Okay, wait, so what are the oils to stay away from?
- [49:20]
B
So mainly, you know, olive oil is the big one for me. That's the one I always fixate on because we use it to grow malassacea furfur, which is the yeast that causes seborrheic dermatitis or that severe dandruff. Ok. I don't want you using that. Coconut oil is used a lot in the hair. I'm okay with that. I don't like it on the skin because it clogs the pores and causes acne. But on the hair, as long as you're washing it appropriately, you can use that. But the big one for me is olive oil because I know that we use that in the lab. What other oils should you use? Oils that I do like. I like jojoba oil, I like argan oil. They're a little bit more similar to our natural oils and sebum. So that's something that I do recommend for my patients.
- [50:01]
A
Scalp massage.
- [50:04]
B
I need, like.
- [50:05]
A
That's a pass, Michelle. When you do it like that.
- [50:07]
B
That's a pass. That's a pass. You know, it's like you can do it but gently. But, like, really concentrated religious massage is probably not gonna help much.
- [50:16]
A
Caffeine shampoo, you know.
- [50:20]
B
You know, people think about. No, I'll pass on it.
- [50:25]
A
Microneedling.
- [50:26]
B
Microneedling actually has some fair data because any. Again, that micro trauma causes the stimulation of those growth factors, just like that resurfacing laser that we discussed. So appropriate. Micro needling. Yes.
- [50:40]
A
Hair transplants in Turkey.
- [50:41]
B
If you're going to Turkey because it's a price decision, don't do it. If you're going to Turkey because you met a physician who has great evidence he or she is an upstanding physician. Talk to us first, and then we'll give you the green light. But I think a lot of people go because they see a good price. Price. And that's not the reason to make any health decisions.
- [51:00]
A
Why is it so popular in Turkey versus other countries?
- [51:03]
B
Some countries really invest in medical tourism. Yeah. And Turkey has made that one of their large sectors.
- [51:08]
A
Okay. All right. Yeah. Didn't know. Thank you so much.
- [51:12]
B
You're welcome.
- [51:12]
A
It's always good to see you. We've never had a full hair conversation like this. We usually are talking skin.
- [51:17]
B
Yeah. This is fun.
- [51:18]
A
We'll have to have you back for skin. But this was like, I just think really, really important because I don't know, I mean, I learned so much today. But also, I think there's a lot of, I know there's a lot of shame in this conversation. All right, Dr. Michelle, thank you.
- [51:31]
B
Thank you.
- [51:32]
A
Well, before we wrap, I just, I want to say this. If you came into this episode feeling worried, overwhelmed about hair loss, I hope you're leaving with some more clarity and a little less fear. Hair loss. And Dr. Michelle said it over and over, it's not a personal failure. It's not something to be ashamed of. And I am so grateful to Dr. Michelle Henry for bringing this real science and compassion to this conversation. Because she's not just doing it here, she's doing it every single, single day in her office. If this episode helped you, please take a moment to leave a review for the Tamsen show wherever you are listening from. And thank you for listening. This really helps other women find these conversations and supports the work we're doing here every week. Thanks for being here and I will see you next time. Today's podcast is sponsored by Midi Health. So many of you know this, but I was dismissed over and over again when I was struggling with perimenopause symptoms. I didn't even know I was in perimenopause. It is so important you're getting care from someone that specializes in women in midlife and that they're willing to have the hormone therapy conversation with you. I get questions from you every single day about where to go for support and I'm always suggesting Midi Health. It's covered by insurance and you don't even have to leave your house. Ready to feel your best and write your second act script, visit joinmidi.comtamsen today to book your personalized insurance covered virtual visitors. That's joinmitty.com Tamsen Midi the care women Deserve. This episode is brought to you by Progressive Insurance. You chose to hit play on this podcast today. Smart choice. Make another smart choice with Auto Quote
- [53:05]
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Explorer to compare rates from multiple car
- [53:07]
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insurance companies all at once. Try it@progressive.com, progressive Casualty Insurance Company and affiliates. Not available in all states or situations. Prices vary based on how you buy.