This is Part 2 of our hair loss series. In case you missed it, here’s Part 1 where we discuss why hair loss happens, how it progresses, and some common myths associated with balding.
Treating hair loss can be complicated. We’ve created this guide so you don’t have to spend hours researching obscure treatments on the internet and looking up PubMed articles. We talk about how each treatment works, link to any evidence showing their effectiveness, and fill you in on anything else you might want to know. As always, talk to a doctor if you have any questions unique to your circumstances and before you start any treatments.
And whatever you, please do NOT buy propecia or avodart from shady websites online. Better safe than sorry.
The Big Three Hair Loss Treatments
1. Minoxidil (aka Rogaine)
Also known as Rogaine, minoxidil has showed moderate results compared to other hair loss treatments in clinical trials. Minoxidil helps prevent hair loss only on the crown (vertex) and it also grows the hair back in some cases to varying degrees but the way it works isn’t exactly known. It’s a vasodilator, meaning it relaxes the blood vessels, and there’s speculation that it extends the growth stage of hair follicles but it doesn’t affect DHT like the other drug treatments we talk about below do.
Minoxidil isn’t a “cure” for balding as much as it’s a band-aid. You have to continually use it in order to keep seeing results. One study found that after discontinuing Minoxidil, the hair count of patients returned to the levels of the placebo group after 6 months.
A 5% concentration of topical Minoxidil seems to be optimal for treatment. One study found it superior to a 2% concentration with patients seeing quicker results and a 45% increase in hair regrowth after about a year (48 weeks to be exact).
Another study also confirmed 5% was the most effective, this time against a 1% concentration. One study which tested a foam based form of Minoxidil found that about 38% of the people using it experienced hair regrowth (except it was only 8% of their original hair).
Again, talk to your doctor before you start using ANY treatments. You’ll get specific instructions on how to use Minoxidil if you decide it’s right for you but if you’re really curious you basically just massage your scalp with the solution and leave it on to absorb for a few hours. Nothing too complicated. If it’s a spray you spray it on instead.
You can get minoxidil over the counter or online where it goes by the name of Rogaine.
2. Finasteride (aka Propecia)
Also known as Propecia or Proscar, finasteride is another treatment used to combat male pattern baldness and while there is some evidence it does a better job than Minoxidil, there are also some additional downsides. First let’s take a look at how it’s different.
Finasteride is orally ingested in the form of a pill, with or without a meal, usually about 1 mg daily, and it works by disrupting the conversion of testosterone to DHT by stopping an enzyme called Type II 5a Reductase. Don’t worry about the scientific stuff too much. Just know that, as we mentioned in the first part of this series, DHT is the hormone that’s primarily responsible for hair loss so unlike minoxidil which only acts on the hair follicles, finasteride actually works on the main contributor to MPB.
The largest study testing finasteride’s effectiveness used 1553 men in two 1-year trials where one group took 1mg a day of finasteride and the other was given a placebo. Patient self-assessment and third party investigators both agreed that “treatment slowed hair loss, increased hair growth, and improved appearance of hair”. This study was done on men with moderate to mild hair loss, not complete. The overall amount of hair regrowth was relatively small but still significant. Again, the sooner you act the better results you’ll see so don’t wait.
In another study comparing 1mg of finasteride a day to a 5% topical minoxidil solution, they actually found that the results between the two groups were mostly the same although 80% of the men taking finasteride responded to treatment whereas only 52% responded to the minoxidil solution.
It takes about 3-6 months to see noticeable results with finasteride and like minoxidil, you have to keep taking otherwise you’d continue losing hair.
As for the downsides, there have been reports of sexual dysfunction among men taking finasteride as a side effect. Although less than 10% of users have reported any dysfunction, we still feel that’s enough to mention as a cause for concern for anyone interested in finasteride. Some people have also noted depression as a side effect.
As always, TALK TO A DOCTOR. We don’t encourage buying any of these treatments over the internet without consulting a professional first.
3. Dutasteride (aka Avodart)
Also known as Avodart, dutasteride is actually more commonly used to treat enlarged prostates rather than hair loss. That said, it’s used off label and it’s much more effective than both finasteride and minoxidil. Like finasteride, dutasteride limits the conversion of testosterone to DHT but while finasteride works only on Type II 5a Reductase, dutasteride does both Type I and Type II. Simply put, dutasteride is the strongest of the big three hair loss treatments.
Some people who don’t respond at all to finasteride show much better progress with dutasteride. In this study, 35 Korean men who took 1mg a day of finasteride for 6 months and didn’t see results were then given 0.5 mg of dutasteride a day for another 6 months. Twenty four of them showed improvement, having their hair thickness increase by almost 19% and their hair density by 10%.
Another study comparing dutasteride to finasteride found that 0.5 mg of dutasteride a day, “significantly increased hair count and width” compared to smaller doses of dutasteride and 1 mg a day of finasteride after a period of 24 weeks. While the recommended dose for dutasteride is usually 0.5 mg, there is another study that shows 2.5 mg is even more effective.
Once again, sexual dysfunction is a potential problem for anyone taking dutasteride. In the Korean study, 6 of the 35 patients reported problems. Seeing how finasteride and dutasteride both change our hormonal levels, this isn’t too surprising.
Unfortunately the same hormones responsible for hair loss are also responsible for a healthy sex life. You’ll have to ask yourself if running the risk is worth the potential improvement in hair count. Having hair is better than having little or no hair, but is it worth the frustration? Again, most patients responded positively and have had no trouble. We encourage you to talk to a doctor about any potential risks.
Alternative Hair Loss Solutions
The following treatments aren’t as well known as the first three we discussed but many people have still reported satisfying results nonetheless so we’re letting you know what all your options are. Again, we only look for options that are scientifically backed and have research supporting their effectiveness.
Hair Loss Pills
Some brands sell hair loss tablets as an alternative to topical solutions and Propecia or Avodart claiming they can regrow hair just as effectively.
These types of products use a variety of different herbs, vitamins, and minerals that may or may not actually regrow your hair. We say that because while some of the common ingredients found within hair loss pills like iron, keratin, biotin, and zinc have real benefits to improving general hair quality, we’re not entirely convinced they’re effective at actually regrowing hair.
If it doesn’t have ingredients which affect DHT, it’s not worth wasting your money on.
So let’s take a look at two different product lines.
The first, Foligen, contains your standard assortment of hair healthy nutrients like magnesium, zinc, biotin, and Vitamin B6. This is good but if your goal is hair regrowth it’s not enough. Thankfully it also contains two noteworthy active ingredients.
The first of which is saw palmetto. Clinical trials back saw palmetto’s mechanism of action which works similarly to Propecia and even Avodart by blocking the conversion of the 5-alpha-reductase enzyme which converts testosterone to DHT. The second ingredient, an extract of the nettle root, also works similarly to saw palmetto.
It’s worth noting that saw palmetto and the nettle root extract are both commonly used to treat BPH (non-cancerous enlarged prostates). As we mentioned in the first part of this series, many of the treatments for hair loss and prostate enlargement are the same because they both work to stop the conversion of testosterone to DHT.
While these two ingredients aren’t as well researched for hair loss as say Propecia, it isn’t a stretch to conclude that they may be of some benefit to hair loss if they both do the same thing.
Foligen is especially ideal for those still in the early stages of hair loss. Think Norwood 1 or 2 on the scale. What makes it so interesting as a hair loss supplement is it contains about 220% of your recommended daily value of Folic Acid, a B vitamin. Folic acid has been extensively researched and even found that those with a deficiency may actually be suffering from premature hair loss!
Other interesting ingredients:
Fo-Ti: A Chinese herb, also known as Heshouwu. This is a little known ingredient that has some backing by Chinese scientists which found an extract induces hair growth in resting follicles — or at least in mice. This is a little known hair loss supplement in the west but has been used traditionally in East Asian cultures as a remedy for balding men.
Horsetail Extract: Another natural herb, this one contains minerals like silica and silicone, which if you’re familiar with the ingredient list of common hair-styling products and/or shampoos, is what they include to strengthen your hair and give it that healthy looking shine. We’ve seen this one in a lot of hair loss products so we thought we’d let you know about where it’s real benefits may lie as there hasn’t been much evidence other than anecdotal reports touting its effectiveness.
The second brand we’re going to take a look at is Viviscal’s Hair Dietary Supplements which is specifically designed for male hair loss (unlike their general hair growth tablets for men and women).
Some of the ingredients are… strange to say the least. It contains a special blend the brand calls AminoMar which is supposed to affect DHT but they don’t exactly specify what the contents of this blend are so we can’t say if it actually works or not (although they do claim it’s been clinically researched and proven to work). The other ingredients like Vitamin C and flax seed extract are nice additions for healthy hair but won’t do anything to regrow it.
One thing about these products is that they should have relatively minimal side effects compared to say Propecia or Avodart so it may not hurt to try them out. Most of the ingredients in these pills are plant based and almost read like a multivitamin so if anything they’ll at least improve our health.
If you’ve tried hair loss pills or supplements in the past let us know in the comments what you think about them. We’re always looking to gather more reliable first hand experience from others and you may be able to help another reader out.
Hair Loss Shampoos
Do hair loss shampoos actually work? It depends. Like any of the treatments we described above, you should expect varying results. What works for one person might not work for another which is why you need to try different things to see what works for you.
The mechanism these shampoos work by is supposed to be the same – they block DHT from affecting the hair follicles. You need a shampoo with ingredients that have anti-DHT properties.
Ultrax Labs Hair Loss Shampoo makes the use of caffeine which is increasingly becoming backed by research showing when applied topically and directly to the scalp, caffeine actually has growth promoting effects on hair follicles. This study performed in 2014, found that caffeine extended the life cycle of the hair follicle thanks to its anti-DHT properties. This study echoes study conducted in 2007 which found caffeine highly increased the growth rate of hair follicles up to 8 days after application.
So if the research is anything to go by, caffeine actually seems to be a highly effective ingredient against hair loss. Who knew?
Like the hair loss pills we talked about above, you’ll also find saw palmetto here along with an ingredient called Ketoconazole which is commonly used to treat fungal infections on the scalp. There has been some research showing that Ketoconazole helps stimulate hair growth in mice and might be able to do the same for humans but research is inconclusive so far. The amount contained within this shampoo is only 0.2% which might be too little to do much but it won’t hurt.
Pura D’or Premium Organic Hair Loss Shampoo also uses a blend of ingredients that potentially affect DHT. We say potentially because research on some of the ingredients is inconclusive. For example, biotin is commonly advertised as a means to regrow the hair but studies haven’t really found any hard evidence. It’s main benefit comes in making your existing hair follicles appear thicker rather than regrowing lost hair.
You’ll also find saw palmetto as well as the nettle root extract which at least have some research backing them up alongside an impressive list of other ingredients like tea tree extract (a scalp simulator), Indian Gooseberry (traditionally used as a means to stimulate hair growth), argan, rosemary, and a variety of other essential oils.
Unfortunately not every ingredient on there has been studied in regards to hair loss so a lot of this is anecdotal and speculation. It can’t hurt to try and you’ll likely avoid any of the potential side effects that come with treatments ingested orally like Propecia and Avodart.
Overall, we say hair loss shampoos are worth looking into as replacements for your regular shampoo just to be given the chance that they might work well for you. Incorporating a hair loss shampoo and taking your daily dose of Rogaine or Propecia will also increase the chances of you saving your hair if you happen to not respond to either one.
While it’s not a route we recommend taking, hair transplants are technically an option to treat hair loss. Here’s the thing – while the the surgical procedure itself isn’t invasive, it is expensive running in the thousands of dollars. Compared to the other treatments, we just don’t think it’s worth it but at the end of the day, it’s your call to make.
While getting a hair transplant, the surgeon relocates the hair from the back of the head to the top. Why? Because the hair follicles at the crown and hairline are much less resistant to the effects of DHT than the hair that grows on the back and sides.
Remember the Norwood Scale? The hairline gradually recedes and the crown starts thinning as you go through the stages. Meanwhile, the hair at the back and sides doesn’t suffer anywhere near as much as the top. The person operating on you literally cuts a piece of your scalp off with a scalpel (with anesthetic thanks goodness), and then creates grafts containing hair follicles which will be transplanted to your bald spots.
It’s actually common to lose hair after the first few weeks of getting a hair transplant. This is called shock loss and it happens because the hair gets “traumatized” from the surgery. This is temporary, and the hair can be expected to grow back in a few months but it will look worse before it looks better. Swelling and itching are also common post-operation and you’ll have to make sure to avoid scabbing because it’ll cause the newly transplanted hair follicles to fall out.
These downsides, the costs and unfortunate side effects, keeps us from recommending hair transplants as a treatment.
That concludes Part 2 of our hair loss series. Click here for Part 3 where we’ll talk about the hairstyles that’ll make you look great in the meantime as your hair regrows.