Analysis of Hair Loss Treatments: The Verdicts

As I discuss in a previous post, it is important to be skeptical of the numerous “treatments” for male pattern hair loss that are available on the market, and to only invest in treatments that are supported by science.  Otherwise, you will be wasting your money and will experience no positive results.  In this post, I will examine a number of products and treatments and assign a “verdict” to each one, indicating whether they have been demonstrated to be effective or not.  This list continues to grow, as I become aware of new products on the market.  If there are any you don’t see here, feel free to suggest one.

Image from http://www.stacaravansgids.nl.

A good philosophy to have when evaluating hair growth products is “guilty until proven innocent.”  In other words, unless and until sufficient studies and clinical trials demonstrate the effectiveness of a treatment on male pattern baldness specifically, one should remain skeptical of that treatment.  So without further ado, here are some of the treatments for hair loss out there and whether or not they are effective for male pattern baldness:

The Good: Backed by Science

For the scientific papers supporting these treatments, see this post.

Finasteride (includes Propecia and Proscar)
Minoxidil (includes Rogaine)
Ketoconazole 2% Shampoo
Low-level laser therapy (LLLT)
Dutasteride (includes Avodart)
Topical Finasteride (see this study.)

The (Probably) Effective: Backed by Some Promising Scientific Studies So Far

Viviscal (Supplements).  Studies have shown that Viviscal improved hair growth in both women and men who were experiencing thinning hair (also see here).  Thus, it does seem to have some effectiveness, but more testing needs to be done, in my opinion.

Plasma-Rich Platelet (PRP) Therapy.  This is a surgical treatment that must be done at a hair restoration clinic.  While it is still in the early stages of testing, some studies have shown that it has an effect on hair growth in men experiencing male pattern hair loss (see here and here, for example).  This procedure is expensive (on the order of $1000 per injection), however, and requires multiple injections over time (every 1 -2 years).

The Possible: May Have a Mild Positive Effect, but Still Largely Untested

Alpecin Caffeine Shampoo.  Some studies have shown that it has a positive effect on hair growth, but its overall effectiveness and ability to slow or stop male pattern baldness is unknown and probably insufficient.  See this post for more information.

Cimetidine (Oral Medication).  A study has shown that it is effective against female pattern baldness (see here), but it has not been tested on male pattern baldness.

Flutamide (Oral Medication).  Studies have shown that this antiandrogen can mildly improve hair loss in women (see here), but it has not been tested for its effectiveness against male pattern baldness.

Niacin.  Definitely helps promote hair growth in females experiencing androgenetic hair loss, but no studies have been done showing that it helps male pattern baldness.

Spironolactone (Oral Medication).  Studies have shown that this antiandrogen can stop or reverse hair loss in women (see here, for example), but it has not been tested for its effectiveness against male pattern baldness.

The Ineffective: May Help Hair in Other Ways, but Won’t Stop Male Pattern Baldness
(In Alphabetical Order)

Biotin.  May help with general hair growth, but no clinical trials have been conducted that show it can effectively counter male pattern baldness (as this study points out).  Biotin deficiency could be a cause of hair loss in some cases (paper), but if the cause of hair loss in a specific case is male pattern baldness, there is no established evidence biotin can help.  Biotin does seem to have some good reviews by users on WebMD, however.

Castor Oil.  Untested on male pattern baldness, but may have anti-inflammatory properties.

“DHT-Blocking” Shampoos or Topical Formulas.  May contain some good ingredients that combat DHT, but no studies have shown specifically that the shampoos can effectively and consistently lower DHT levels to the extent that would slow or stop male pattern baldness (in contrast to ketoconazole, which blocks DHT and has been shown to counter male pattern baldness.  See above).

Folicure.  Does not appear to contain ingredients that block DHT.  Even if it did contain such ingredients, it would fall under the same category as DHT-Blocking Shampoos: its ability to reduce DHT to the extent that male pattern baldness is slowed or stopped has not been tested.

Hairomega (Supplements).  Contains some ingredients such as niacin and saw palmetto, neither of which have been proven to significantly counteract hair loss in men (see above and below).

Nanogen Hair Growth Factor (or Serum).  Does not contain ingredients that counter DHT, the cause of hair loss in men.  More importantly, it has not been tested independently for effectiveness against male pattern baldness.  It may help thicken hair in other ways.

Nizoral 1%.  Contains 1% ketoconazole, similar to Regenepure.  While Nizoral 1% has been shown to reduce shedding, it does not increase hair density in those experiencing male pattern baldness.  The concentration that helps with male pattern baldness is 2%.

Regenepure. Contains 1% ketoconazole, which slightly reduces DHT and is good for shedding, but does not increase hair density in men with male pattern baldness.

Revivogen Scalp Therapy & Shampoo.  Falls under the category of DHT-Blocking Shampoos & Formulas: hasn’t been tested enough.  In addition, the reviews on Amazon.com are mixed.

Saw Palmetto.  A study showed that 320 mg/day of saw palmetto reduced prostate DHT levels by 32% after six months.  (Finasteride reduced DHT by 80% in the study.)  However, saw palmetto did not reduce blood levels of DHT.   Thus, it is questionable whether or not it would have any effect on male pattern baldness.

Helpful – But Not Sufficient – Tools

In the fight to counteract the natural process of hair loss and maintain hair growth, it is wise to invest in one or more of the scientifically supported tools such as finasteride, minoxidil, and/or low-level laser therapy, rather than spending money on just any so-called “solution” promoted by infomercials, nutrition shops, or the Internet.  The truth is, most shampoos, supplements, and devices claimed to help hair loss are not scientifically supported, and will probably be a waste of money.  However, it turns out that there are two products which, although possibly not strong enough on their own to counter hair loss, actually produce a measurable effect on reducing hair loss.

Image from fitnessaims.com. There are a lot of hair loss “products” out there on the market; don’t be fooled by ones that are not backed by research.

 

Ketoconazole (2%) Shampoo

Probably the most important “small” but effective tool in this regard is a type of shampoo known as ketoconazole shampoo, an antifungal agent that is usually marketed for controlling dandruff.  One of the most common brand names for this shampoo is Nizoral, which you can pick up from your local drugstore.  The good news for those who experience hair loss is that this substance has been demonstrated to suppress the activity of androgens such as DHT, the hormone that causes hair loss.  Several scientific papers have discussed this:

Reversal of androgenetic alopecia by topical ketoconazole: relevance of anti-androgenic activity, Journal of Dermatological Science.

A Prospective Randomized Trial Comparing Low Dose Flutamide, Finasteride, Ketoconazole, and Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism, Journal of Clinical Endocrinology & Metabolism.

Interestingly, while the second study has nothing to do with hair loss in men, it does show that ketoconazole hinders the effects of the hormone responsible for hair loss, DHT.  Have studies been done specifically on the effectiveness of ketoconazole on stopping hair loss in men?  Yes, and so far, the results are promising:

Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men

Comparative efficacy of various treatment regimens for androgenetic alopecia in men

Ketoconazole shampoo: effect of long-term use in androgenic alopecia

In each trial, it was found that 2% ketoconazole shampoo effectively reduced the activity of DHT and had a positive effect on hair growth in men experiencing male pattern baldness.  In the last study, ketoconazole alone produced the same effect on hair growth as 2% minoxidil.  (However, note that the more commonly used concentration of minoxidil today is 5%, which is a stronger solution.)  Interestingly enough, the “hair density” increased by a greater percentage in those who used ketoconazole compared to those who used 2% minoxidil.  In the group of men using ketoconazole, the density started at 250 hairs/cm^2 and increased to 296 hairs/cm^2 at the end of the six-month trial, which is a (296 – 250)/250 = 0.184 = ~18% increase.  In the group of men using 2% minoxidil, the density started at 276 hairs/cm^2 and increased to 306 hairs/cm^2 at the end of the trial, which is a (306 – 276)/276 = 0.0108 = ~11% increase.  (You can read about the details in the full paper.)

In addition, unlike the 2% minoxidil, ketoconazole was found to decrease the activity and amount of DHT on the scalp.  Of course, more studies need to be done to further confirm these results.  There are important things to note about this tool, however:

1. The researchers used a 2% concentration of ketoconazole in the experiment.  Over-the-counter shampoos such as Nizoral often only hold a 1% concentration, which seems to effectively stop shedding and increase hair shaft diameter, but not increase hair density.  Thus, the most effective tool would be a 2% ketoconazole shampoo rather than a 1% shampoo.
2. In the experiments, the shampoo was applied 2 – 4 times each week.
3. The shampoo was used for at least six months, and up to 21 months in one study.

It appears that 2% ketoconazole shampoo is an effective tool for combating the process of hair loss.  In addition, it is relatively inexpensive, compared to the other treatments such as minoxidil, finasteride, and low level laser therapy.  Furthermore, it only needs to be applied three or four times per week.  Overall, it seems to be a good tool to include in the arsenal.  However, as with all tools for fighting hair loss, it has to be used consistently and indefinitely, since the hair loss process is always “fighting” to weaken the hair follicles.

Caffeine Shampoo?

Another substance that does not have quite as much research supporting it, but seems to definitely have positive effects on hair growth, is caffeine, and specifically a caffeine-fortified thickening shampoo known as Alpecin, made from a formula developed by Dr. Kurt Wolff, a dermatologist from Germany.

One study was conducted and showed that caffeine delivered to the scalp has a positive effect on hair growth, and counters the negative effects of testosterone on hair:

Effect of caffeine and testosterone on the proliferation of human hair follicles in vitro, International Journal of Dermatology.

Image from http://www.alpecin.de. Caffeine complex in Alpecin shampoo seems to at the very least reduce the negative effects of testosterone on the hair follicles.  However, this study did not look at the effects of caffeine on DHT, which is the more important hormone when it comes to hair loss.

Another study specifically tested the caffeine-fortified Alpecin shampoo on those who experience male pattern baldness, and found a positive effect at the end of six months of consistent use:

Efficacy of a cosmetic caffeine shampoo in androgenetic alopecia management

While this study is interesting, it is important to note that the results were based on SELF-analysis of the participants.  In other words, unlike the studies supporting ketoconazole, the results weren’t based on precise measurements by experimenters on hair density and other factors, but on the self-reports of those who used the shampoo.  However, that doesn’t mean the results are useless; after all, if the person experiencing hair loss notices an improvement, that definitely counts for something.  At the same time, it is hard to know how effective this treatment is overall on the process of hair loss, and whether or not it actually slows or stops hair loss long-term.  In my personal experience, this shampoo produces immediate positive thickening effects, and seemed to even keep my hair thick over time.  However, while using it, I still did notice my hair loss continue to progress.

Overall, both 2% ketaconazole shampoo and caffeine-fortified Alpecin shampoo seem to be effective, inexpensive tools for managing hair loss and even increasing hair growth.  However, they need to be used properly and consistently.  Are one or both of them sufficient on their own to stop hair loss?  It is hard to say.  However, at the very least, they do seem to help in a way that is measurable.

My Experience and Recommendation

I began conducting research on the causes of a receding hairline and balding when I myself began to notice a receding hairline at age 27.  Knowing that my grandfather on my mother’s side had experienced a receding hairline throughout his life, I suspected that this could be in my future as well.  (However, note that hair loss could also be inherited from your father’s side.  See this study.)  As a result, I did some research and experimented with various solutions.  I am currently 30 years old, and this is what I have found so far:

For the first year and a half, I did not invest in any of the three scientifically supported tools of finasteride (Propecia), minoxidil (Rogaine), or low-level laser light.  I used more mild “solutions” such as Caffeine-fortified thickening shampoo and a product called Revivogen.  As anyone who is familiar with this website knows, there is not enough reliable evidence that such uncertain “solutions” could effectively counteract the process of male pattern hair loss.  I found this to be confirmed in my personal experience.  Throughout my time using these “treatments,” although there seemed to be temporary positive effects (such as thickening caused by shampoo) at times, I noticed that my hairline continued to recede or hair began to thin in the middle of my head, even in areas that were not receding.  As a result, I knew I had to use more “serious” tools if I were to be successful.

In September 2014, I obtained a prescription for finasteride from a local hair restoration clinic.  I took finasteride for about two months, and I did not like the side effects, so decided to stop.  Most doctors will say that you should not expect to notice any positive results when it comes to hair stabilization or regrowth until after you have used a specific treatment consistently for at least 4 – 6 months.  Thus, the fact that I did not notice much difference in the effects of my hair during the two months using finasteride does not really reveal anything significant.

Hair growth treatments are supposed to move hair out of the resting (telogen) phase and into the growth (anagen) phase, which results in a lot of shedding initially as “older” hairs fall out to give way to newer hair. Image from http://www.bellassecret.com.

In November 2014, I purchased the Capillus Laser Cap at another hair restoration clinic.  The Capillus Laser Cap is the most powerful in-home laser device currently available, with 272 laser diodes.  Unfortunately, it costs around $3000.  I began using the Laser Cap consistently (every other day for 30 minutes each time) and applying minoxidil (two applications per day, one in the morning and one at night).  For the first 2 – 3 months, as expected, I did not notice any positive benefits for my hair.  In fact, it seemed at times my hair was thinning faster.  Supposedly, this is to be expected as the thinner, dormant (telogen) hairs are being “pushed” out to give room for newer, thicker hair (due to the hair growth cycle).  Around 4 months of using BOTH the Laser Cap and minoxidil (Rogaine), the thinning seemed to stop and my hair seemed to be slightly thicker.  The treatment seemed to be working.

At some point, I experimented by discontinuing use of the minoxidil and only using the Laser Cap.  I noticed no significant negative effect.  In fact, as I continued to use the Laser Cap up through May 2015 (a total of about 6 months), my hair continued to thicken noticeably, the hair loss apparently stopped, and my hair growth seemed to stabilize.  This occurred from using only the Laser Cap for about two months after discontinuing the minoxidil.  However, it is possible that those two months were the remaining effects of using the minoxidil previously.  Most doctors will tell you it takes a few months for the benefit of a treatment to be noticeable as well as the effects of stopping a treatment to be noticeable.  Thus, it is not possible to conclude that the Laser Cap alone produced those effects.  At the very least, I can conclude that consistent use of the Laser Cap + minoxidil was effective.

At this point, I discovered a newer device on the market called the Theradome laser helmet.  Theradome has significantly less lasers than the Capillus Laser Cap (80 as opposed to 272) and costs significantly less ($895 as opposed to $3000).  I decided I would try this less expensive device and see if it worked effectively enough to keep my hair growth stable.  I returned the Capillus Laser Cap, and began using the less powerful Theradome laser helmet in June 2015.  I have been using Theradome consistently for 6 months.  Since I have used the device consistently for this amount of time, I am able to accurately assess its effectiveness (6 months is the amount of time it should take for the effects of a certain treatment to become established).  What can I conclude?  Throughout the six months of using the device, I have noticed my hair loss continue to progress, and I have lost more hair (especially on the top of my head) since I stopped the Laser Cap/minoxidil and began using the Theradome.  There may be some thickening effects, but it doesn’t seem to be strong enough to stop the progression of my hair loss.

If the tool you are using is not strong enough to counteract the destroying effects of DHT on hair follicles, hair loss will continue to progress, though possibly slightly slower. The goal is to slow it down as much as possible or stop it altogether, which requires a sufficiently strong enough tool (or tools) to counteract the weakening effects of DHT. Image from http://www.zieringmedicalcalifornia.com

My experience and experimentation with different hair growth methods leaves some questions, since I have not tried every tool or every possible combination of tools.  So far, it seems that the Laser Cap plus minoxidil or possibly the Laser Cap alone seems to do the job, if I am consistent.  I also know that the less powerful Theradome alone does not do the job.  Does that mean 80 lasers + minoxidil would work?  Or 80 lasers + finasteride?  Or perhaps 80 lasers + minoxidil + finasteride?  Or possibly minoxidil + finasteride, or finasteride alone?  I cannot draw any conclusions at this point about any of those options, since I haven’t tested any of them for a sufficiently long period of time (6 months).  Perhaps one or more of those would work.  The question to ask then is: What conclusions can we draw from my experiences?

If I were to classify the level of aggressiveness of my particular hair loss, I would say it is moderate.  I define “moderate” as not aggressive enough to go mostly or totally bald by age 30, but more aggressive than having a slowly receding hairline and no other type of hair loss up until age 60.  I will define aggressive as beginning to experience hair loss at age 20 or earlier and/or becoming completely bald (except at the sides and back of the head) by age 30.  I will define mild as having no receding hair line or having a very slow receding hairline that hardly changes even into the 50s.  In summary, the levels of aggressiveness are:

Mild – No receding hairline or a very slowly receding hairline, with most hair still apparently intact at age 60.

Moderate  – Receding hairline begins at late 20s, hair thinning occurs noticeably to the individual over a short period of time even on the top of the head.  Complete baldness will probably not occur right away, but may occur after 60.

Aggressive – Receding hairline and/or noticeable hair thinning begins at age 21 or earlier.  The hair loss occurs quickly, and most or all of the hair on top of the head is completely gone by age 30 (in the absence of any treatment or tools).

What can we conclude from my experience trying various solutions, someone who apparently has a moderate level of aggressiveness for hair loss?  It seems that a combination of minoxidil and the more powerful (i.e., with high laser output), 272-laser diode Laser Cap is strong enough (at least for awhile) to counteract my particular hair loss, and even increase my hair’s thickness.  It also seems that the less powerful, 80-laser diode Theradome is not powerful enough to counteract a moderate level of aggressiveness, at least on its own.  Based on all of these results, you could try to determine the level of aggressiveness of your particular hair loss, and then take into consideration my particular recommendation to counteract that level of aggressiveness:*

Mild – You can choose to do nothing, or you can choose to try minoxidil (Rogaine or generic).  A ketoconazole shampoo might be beneficial as well.   It may not be necessary to take finasteride (Propecia or generic) or use the more powerful laser caps with over 200 laser diodes.

Moderate – A laser device with less than 200 laser diodes (on its own) may not be enough to stabilize your hair growth.  It is possible that an 80-laser diode device would work in combination with minoxidil (Rogaine) and/or finasteride (Propecia), but you would have to test that over a period of at least 6 months to know for certain.  The more powerful laser devices (with more than 200 laser diodes) may or may not be sufficient on their own to stabilize your hair growth, but you could try that for 6 months – 1 year to know for sure.  However, a combination of the 200+ diode Laser Cap and minoxidil might be sufficient to halt your hair loss and even improve hair growth.  It is unknown whether or not finasteride (Propecia) on its own would stabilize your hair growth, or finasteride + minoxidil only.  I base all of these conclusions on my own experience of what I have or have not tried.  It is possible that finasteride alone might be enough to slow down this type of hair loss significantly, since studies show that its effect is quite powerful (see this study, for example).

Aggressive – It is uncertain what the minimum treatment would have to be in order to halt your hair loss and stabilize hair growth, but the most effective tools known are finasteride/dutasteride, minoxidil, 2% ketoconazole shampoo, and the more powerful laser cap devices (the ones with over 200 laser diodes).  It has also been found that using a combination of two or more treatments produces the most powerful effect (see this study about various combinations and this study about combining treatments with laser therapy).  If you are experiencing an aggressive type of hair loss, you probably need to use a combination to effectively slow or stop it.  Make sure that when you do so, you use the regimen consistently and over a time period of six months to a year before drawing any conclusions, otherwise, you will not be able to make an accurate assessment.

If you are reading this and can identify with any of the above categories of the type of hair loss and would like to experiment with any of these treatments, I would also be interested in seeing what you find out.  You are welcome to share with me what you discover if you would like to, so that I can gain a better understanding as well.

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* I am not a doctor. You should always consult a board-certified hair restoration doctor before making any decisions about hair loss treatments. The opinions on this blog are solely those of myself. However, I try my best to develop informed opinions by basing them on the results of clinical studies that I reference here on my website.

Be Skeptical: Science vs. Hype

There are many, many so-called “solutions” to balding or a receding hairline out there, but it is always wise to be skeptical about any claim unless there are published studies supporting that claim. In addition, the studies should be done by an independent source, not just the company selling or promoting the product. Furthermore, even for the legitimate, science-based solutions, it is important to know what type of solution is appropriate for each situation. For example, even though Rogaine (minoxidil) is a well-known and effective hair loss solution for men, relying on Rogaine alone to stop hair loss may not work in some cases. In addition, there are certain things it may not be able to do when it comes to hair loss, such as grow new hair on some completely bald spots. Even among the good solutions, not every solution targets every problem in hair loss. You need to choose a specific solution for your specific situation.

Among the legitimate solutions, you need to also be careful who you are buying the solution from. Some solutions can be good solutions in general (such as hair transplant surgery), but if the company or surgeon does not have a good reputation or cannot produce good results, you need to avoid that company or surgeon. It is wise to always be skeptical before you dole out your money to someone promising a solution to your hair loss.

http://www.urah.com.sg

When you come across a new hair loss product or “solution,” a good rule of thumb is to research whether or not any scientific studies or clinical trials have been conducted that support its effectiveness. Make sure you only spend money on something that has good research supporting it.

Hair Loss Products

Products advertised as “hair loss products” include finasteride (Proscar and Propecia), minoxidil (Rogaine), low-level laser therapy (LLLT), “hair omega” pills, Viviscal supplements, Revivogen, saw palmetto, hair thickening shampoos, etc. Not all hair loss products are created equal, however. In order to decide whether or not you want to spend money on something, find out whether or not there have been any peer-reviewed studies demonstrating its effectiveness. If there are no studies showing its effectiveness, it is probably a waste of money. I discuss many of these products on my website here, along with links to various studies, so you can decide for yourself what might be worth using or not.

http://www.positionlogic.com

Hair Loss Treatments/Procedures

Hair loss treatments involve more expensive solutions such as hair transplant surgery. If you can afford it and have decided to undergo one of these treatments to address your hair loss, be certain you do your homework when deciding on a specific surgeon or clinic.

For hair transplant surgery, there are two essential things the surgeon must have before you trust them with your hair: experience and good results. Check the website to see how many years of experience the person has had specifically with hair transplants. (Being board-certified is definitely important.) Take a good look at Before & After photos of actual patients, and decide if you are satisfied with the results. While pictures are definitely not 100% reliable (and can often be manipulated to create the appearance of good results), at the very least, make sure the pictures aren’t bad!

Why Hair Loss? The Causes

That may be the question that you are asking yourself: Why am I losing hair? Well, don’t worry, there is a well-known biological reason for it, and 34,999,999 other men in the United States experience it too (assuming you live in the United States).

http://www.dailytelegraph.com.au

Very rarely (relatively speaking), the cause of hair loss in men could be something abnormal, such as stress, nutritional deficiencies, or some other problem. If you notice your hair falling out rapidly, you need to make an appointment with your doctor. More likely, however, your hairline recession is due to a common process known as androgenetic apolecia, or “male pattern baldness,” which over 85% of men experience. This accounts for more than 95% of men who experience hair loss, so your hair loss is most likely due to this natural process, rather than some disease or abnormal situation.

This type of hair loss (characterized by a receding hairline, losing hair at the crown, and sometimes losing all hair on the top of the head) is due to an enzyme called dihydrotestosterone (DHT), which is a byproduct of testosterone. The genetics of some men causes their body to produce a substance known as 5-alpha-reductase when they reach a certain age. This enzyme reacts with the testosterone in the man’s body, producing a new substance known as dihydrotestosterone. This substance binds to hair follicles and weakens them before they are able to complete their growth phase. Eventually, this causes hair follicles to fall out and balding to occur.

That’s right. The culprit for male pattern hair loss is a single chemical known as DHT. The good news is that some of a man’s hair is permanently resistant to these effects. The hair on the back and sides of your head will most likely remain intact for the rest of your life, even if you experience hair loss. That is why even men who experience the most hair loss still have a “wreath” of hair around their head.

The stages of hair loss in men, known as the Norwood scale. Image from http://www.evolvehairclinic.com.

It is important to know that DHT is the root cause of hair loss in men, because it means that the solution to hair loss is very simple (theoretically speaking): find a way to either stop the production of DHT or offset the effects of DHT. If DHT stops being produced, it will stop attacking your hair follicles, and your hair will be able to grow normally. Thus, it is very important to realize that:

Any product that does not directly block DHT is probably useless in stopping hair loss. (The exception to this would be products that enhance hair growth enough to offset the weakening effects of DHT.)

The substance that attacks hair follicles and leads to hair loss. Image from hairloss.org.

Therefore, any shampoo, supplement, drug, vitamin, food, etc. that does not block DHT will have no effect whatsoever on the root cause of your hair loss (unless it stimulates hair growth and offsets the effects of DHT). This is important to keep in mind when you are buying products to address your hair loss, so that you do not waste money.

Are there any special foods, nutrients, or exercises that will significantly reduce DHT, the culprit of hair loss in men? That doesn’t appear to be the case. This means that even if you eat healthy and exercise often, you could still experience hair loss. You should not trust every claim out there about a certain product or procedure that supposedly will give you hair back or stop balding; it is important to make sure the product being offered has scientific research to back it up.

What types of products have been scientifically demonstrated to block DHT, the cause of hair loss? Surprisingly to some perhaps, Rogaine (or generic minoxidil) is not one of them. Instead, Rogaine works to stimulate hair growth, theoretically counteracting the weakening effect by DHT. Even though Rogaine does not block DHT, studies have shown that it can be effective in increasing hair growth in a mild way. It is worth trying, but because it does not block the source of the hair loss, you may need to supplement it with something else if you have a receding hairline.

The only FDA-approved drug that actually blocks DHT is finasteride, often sold as Propecia or Proscar. Finasteride is available as pills and is definitely effective in slowing/preventing hair loss and promoting hair growth, precisely because it blocks the main cause of hair loss (DHT). The only issue to be aware of is that finasteride can have some internal side effects, because it is taken in pill form. It has been known to cause erectile dysfunction and/or libido loss in some men who take it. It is important to know the risks so that you can make an informed decision as to whether or not you want to try something like this.

The important thing is that once you know what the actual cause of your hair thinning is, you can focus on solutions that address the root of the cause if you want to maintain the hair that you currently have.

To examine your particular hair loss situation and how to address it, click on the following link:

What Particular Stage of Hair Loss Am I At?

Restore Hair that was Lost

Perhaps you have already lost a substantial amount of hair, and want to gain that hair back and have a full head of hair again. Or perhaps you have just lost a small amount of hair and are already taking steps to halt hair loss, but you still want to restore your hairline to where it was previously. Using methods that slow down or stop hair loss (such as finasteride, minoxidil, low-level laser therapy, etc.) will not cause new hair to grow in completely bald areas. Thus, in order to bring your hairline back to where it was originally or fill in the top of your head after it has gone bald, you essentially have two options:

Hair Transplant Surgery. A hair transplant surgery involves extracting hair from the back and sides of the head (where the hair is resistant to the effects of DHT) and transferring that hair to the bald areas of your head. Since the hair comes from a region where DHT cannot affect it (called the “donor site”), the new hair will grow permanently. There are two types of hair transplant surgery: FUT (Follicular Unit Transplantation), which involves harvesting and transplanting strips of hair, and FUE (Follicular Unit Extraction), which takes smaller, individual “packets” of hair. FUT is less expensive, but it leaves a permanent linear scar on the back of the head, which usually can be covered up with the hair that remains.

This is an excellent way to restore hair to areas of your head where hair was lost. However, note that the amount of hair you can use is limited by the amount of hair available on the back of your head. Thus, you may not be able to completely restore ALL of the hair you once had (depending on the stage of baldness you are at), but a hair transplant will most definitely improve the amount of hair you have.

Another thing to be aware of is the possibility of “shock loss.” Shock loss is the shedding of hair that occurs due to the effects of the surgery. Many times, the hair loss is temporary and the hair grows back. You need to be aware of the possibility of shock loss (and that you may permanently lose that hair), and make sure you thoroughly question a potential hair transplant surgeon on your personal risk for that.

Hair Replacement. Hair replacement does not have the same restrictions or risks that a hair transplant does, since hair replacement is non-surgical and there is an unlimited supply of hair available. It involves a hair “system” that is installed on your scalp and grows. The system is composed of real human hair that grows along with your real hair. It requires maintenance at a clinic roughly once every month. This is a great option if you want to completely restore your “full head of hair” look and restore your hairline to exactly where it was before you started experiencing hair loss. However, it is less natural than the hair transplant option, since it does not involve your own hair.  This video shows a good example of someone who has used a hair replacement system to restore his hairline before going mostly bald.

As noted, hair replacement does not have the same risks that a hair transplant surgery does. That is why you need to be more cautious when considering hair transplant surgery than you do if you just want a non-surgical hair replacement. When planning a hair transplant surgery, choose a surgeon with:

Many years of experience specifically in hair transplant surgery.
A good “Before & After” photo gallery with results that YOU like.
Board-certification in cosmetic surgery (at least), member of American Board of Hair Restoration.

Also, check out more than one hair transplant clinic and talk to various surgeons before moving forward. Probably the biggest risk you need to be concerned about is the possibility of permanent “shock loss” of hair you still have after receiving a hair transplant surgery. In many cases, the hair will grow back, but it is still possible that it won’t. Talk to a surgeon about this as well before moving forward.

There are many, many men who have experienced hair transplant surgery and are very satisfied with the results, so this could be a great option if you want to restore some of the hair you lost. If you don’t want the risks of hair transplant surgery and you don’t want any restrictions on the amount of hair needed, you can try the non-surgical hair replacement system. However, it will not be as natural as a hair transplant because it does not contain your own hair growing in your scalp naturally.

Maintain Current Hair (Stop Hair Loss from Continuing)

NOTE: This article discusses low-level laser therapy (LLLT) as an option for treating male pattern baldness.  This treatment is included because several scientific studies have shown that it is effective, which are referenced.  However, in my personal experience, I have only received benefit from using a 272-diode laser cap in conjunction with minoxidil.  I tried the Theradome laser cap (which contains 80 diodes) on its own for six months, and it did not stop the progression of my hair loss.  This suggests that either it is not powerful enough, it is a poor device, or my hair does not respond to low-level laser therapy.

 

There are two ways to address the root cause of hair loss in men: inhibit (block) the production of DHT, the chemical that causes hair loss, and/or stimulate hair growth to offset the effects of DHT. Either method will slow down or stop the process of hair loss, but it won’t create new hair on completely bald spots. To replace hair where it has been lost, you need to get a hair transplant or hair replacement system.

In general, it is a good idea to use at least one inhibitor in combination with at least one “stimulator” in your regimen for countering hair loss, as that will increase the effectiveness of your treatment.  A study showed that men who used both minoxidil (a stimulator) and finasteride (a DHT inhibitor) in combination experienced more benefit for their hair than men who used only one or the other on its own.

Inhibitors

One way to halt the process of hair loss is to slow down or block the production of DHT, the root cause of hair loss.

1.  Topical Ketoconazole.  As of now, the cheapest way to slow down and possibly stop hair loss is to use 2% ketoconazole shampoo 2-4 times per week.  As the link I just posted discusses, scientific studies have demonstrated that it blocks the activity of DHT on hair loss.  Those studies also show that it had a positive effect on hair growth in men experiencing male pattern baldness after six months of use.

There are two other well-tested “blockers” (inhibitors) of DHT out there on the market.

2. Finasteride (generic or Propecia) and dutasteride (generic or Avodart).  Finasteride is a FDA-approved prescription drug that is taken orally. Finasteride has been found to slow DHT production and hair loss, in multiple scientific studies:

Finasteride in the treatment of men with frontal male pattern hair loss

Clinical dose ranging studies with finasteride, a type 2 5α-reductase inhibitor, in men with male pattern hair loss

Efficacy and tolerability of finasteride 1 mg in men aged 41 to 60 years with male pattern hair loss

Finasteride in the treatment of men with androgenetic alopecia

Because there is so much research backing up the effectiveness of finasteride, this product is a good example of something that is science-based rather than hype-based. Thus, it will most likely not be a waste of money in your plan to deal with hair loss.

Note: Finasteride/Propecia may have side-effects of erectile dysfunction or decreased sexual drive. It is up to you whether or not you want to take that risk in order to control hair loss. You can opt to skip finasteride and try other strategies if you want to avoid that risk.*

To obtain Propecia or generic finasteride, simply go to your doctor or to a hair restoration clinic and ask for a prescription.

Dutasteride (generic or Avodart) is another prescription drug that significantly reduces the production of DHT. However, you should be aware of possible side effects, just as with finasteride.  You should also not take both dutasteride and finasteride over the same period of time; only one of the two should be taken at a time.

 

Stimulators

Another way to halt the process of hair loss is to over-stimulate growth in the hair follicles in order to overcome the weakening effects of DHT on hair.  Using a stimulator in combination with an inhibitor will provide an even stronger effect than using only one of the two (as the study I mentioned above suggests).  There are a few stimulators currently available on the market that seem to be supported by scientific studies:

1. Rogaine (or generic minoxidil). This is an FDA-approved over-the-counter topical solution that has been shown to usually enhance hair growth in men with progressive hair loss. It has been shown to effectively regrow hair on the crown of the head, and it may also help a receding hairline.

It has also been shown that the use of Rogaine and finasteride (Propecia) together produces better results than using either one on its own. (However, be aware that finasteride has the possible side effects of erectile dysfunction and/or low libido in some men.)

If you are experiencing a receding hairline, minoxidil may or may not work very well on its own. I recommend adding finasteride and/or laser treatment to deliver a stronger punch.*

2. Low-Level Laser Therapy (LLLT). This involves immersing your scalp in low-energy (safe) lasers that are supposed to increase blood flow and stimulate hair growth. You can obtain laser treatment via a home laser device (the most powerful of which is the Capillus Laser Cap) or at a hair restoration clinic. There are several scientific studies that demonstrate that low-level lasers can increase hair growth:

Low Level Laser Therapy and Hair Regrowth: An Evidence-Based Review

Use of low-level laser therapy as monotherapy or concomitant therapy for male and female androgenetic alopecia

Low-Level Light Therapy for Androgenetic Alopecia: A 24-Week, Randomized, Double-Blind, Sham Device–Controlled Multicenter Trial

Low-level laser (light) therapy (LLLT) for treatment of hair loss.

Hair Regrowth and Increased Hair Tensile Strength Using the HairMax LaserComb for Low-Level Laser Therapy

In addition, Laser Therapy (such as that done via the home device Laser Cap) seems to show some results in hair growth aesthetically (although you should always be skeptical of pictures):

Before & After Photos

A good comparison of many of the in-home laser devices can be found here.

The idea is that the stimulation of hair growth resulting from laser treatment may offset the weakening of the hair follicles caused by DHT. If that is the case, then hair loss will be slowed down or halted and you can maintain the hair you currently have. However, some lasers on the market are less effective than others, so make sure that the laser you invest in has a high number of lasers. The more aggressive your hair loss is, the more powerful of a laser you may need.  The laser devices I am aware of in order of increasing power are the Laser Comb ($295 – $545), the iGrow laser ($695), Theradome ($895), and the Capillus Laser Cap ($799 – $3000, depending on which device you buy).  (Note: I purchased the Theradome and tried it for 6 months, and did not notice any significant positive effect on my hair growth.  See below.)

In my experience, the 80-laser diode Theradome did not help my hair loss.  This might mean that either my particular type of hair loss is too aggressive to be affected by a device with only 80 lasers, or that the device itself is of low quality.  The 272-diode Capillus Laser Cap did seem to have positive effects on my hair growth, although I also used minoxidil at the same time, so it is not possible to draw any definite conclusions for myself.

 

Some treatments such as low-level lasers may stimulate hair growth. Image from http://www.irestorehairlaser.com.

There are no known harmful side effects of laser therapy, since the laser is not thought to penetrate through the scalp. Always ask a doctor before trying any laser treatment, however.

 

So there you have it.  If you want to slow down or halt the cause of hair loss at its “roots,” use at least one product that blocks DHT production and at least one product that stimulates hair growth.  Finasteride and dutasteride block DHT, but they sometimes give side effects in some men that you need to be aware of.  2% ketoconazole shampoo also seems to reduce the effects of DHT on the hair, but not quite as effectively as the oral medications.  Products that seem to stimulate hair growth include minoxidil and low-level laser therapy (LLLT).

If your hair loss is especially aggressive and you want to keep all of your hair, you may want to try a synergistic approach and use all three treatments: finasteride (or dutasteride), minoxidil, and laser therapy.*  See My Experience and Recommendation for more suggestions.

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*I am not a doctor. You should always consult a board-certified hair restoration doctor before making any decisions about hair loss treatments. The opinions on this blog are solely those of myself. However, I try my best to develop informed opinions by basing them on the results of clinical studies that I reference here on my website.

“Help! I’ve gone completely bald. Is it too late?”

Absolutely not! Whether you want to opt for shaving your head like tons of other successful and respected men have or you want to restore that look of having a full head of hair, there is certainly hope. Actually, everything I wrote in “My Hairline Has Receded Substantially and I am Losing (or Have Lost) the Hair on my Crown” applies to you, with the exception of needing to maintain hair. There are basically two options for restoring hair to your head, if that’s what you want to do:

1. Hair Transplant Surgery
2. Hair Replacement (using a hairpiece)

Hair transplant surgery will probably not bring your hairline back to its original position (since there is a limited hair supply in the back of your head), but it will certainly fill in some gaps and restore a substantial amount of hair. Many men have undergone this surgery and are satisfied with it.

If you want that look of a complete and full head of hair, your only option (at least with current technology) is probably virtual hair replacement, which involves using a hairpiece. There are no limitations to the amount of hair you will want to use or the hair style you would want. It also gives a very natural look, as you can see from these photographs – assuming this clinic is reliable!

So whether you want to go Jason Statham or Bruce Willis, or you want to bring back a full head of hair, there are satisfying options for you! Good luck in your decision.

“My hairline has receded substantially and I am losing (or have lost) the hair on my crown and top.”

This is known as Stage IV or V of Male Pattern Hair Loss, measured by something called the Norwood Scale. This means you have experienced hair loss for some time. Is it too late to do anything about this or to “fix” it? Definitely not. First, there are plenty of men (including famous Hollywood celebrities) who simply opt for going bald, so that is certainly one solution to the “problem.” However, some men may not want to go that route, and if you are one of them and you have it in your budget, there are ways to restore some of your former hairline.

This section corresponds to the middle stage in the above diagram for male-pattern hair loss. You have lost a substantial amount of hair, but there is still some on the top. Image from http://www.theprivateclinic.co.uk.

The first thing you want to do is make sure you can maintain the hair you still have left on the top of your head. The way to do that is through the maintenance procedure as outlined in this section. You must consistently apply the well-tested treatments of finasteride, minoxidil, and/or low-level laser light therapy.  (Using a combination of treatments seems to produce the most powerful effect.  See this study, for example.)  If you skip this step, you may lose the remaining native hairs you have on the top and crown of your head.

The second step is to consider replacing the hair you have already lost. The primary way to do this involves filling in the bald spots with your own hair via a procedure known as hair transplant surgery. In short, this involves extracting hair follicles from the back and sides of your head (called the “donor site”) and transferring those hair follicles to the places where there is no hair. Because this hair is taken from the back and sides of your head (which is “protected” from the hair loss caused by DHT), the hair that is transplanted will continue to grow the rest of your life. There are three concerns to be aware of, however:

1. Because you have a limited hair supply in the back and sides of your head, you may not be able to completely fill in every spot of your head that used to have hair. In addition, the new transplanted hair will not be as dense as the previous hair that grew on your head. However, a good hair transplant surgeon can make the results look very close to what you had originally.

2. There are two types of transplant surgeries: FUT and FUE. The FUT transplant procedure involves harvesting hair from the back of the head, so that will leave a thin but permanent scar on the back of your head. However, if you don’t keep your hair too short, it probably won’t be an issue, because the hair will cover up the scar. FUE does not result in any long scar, as it involves taking smaller “bunches” of hair rather than taking a strip of hair. Nowadays, hair transplant surgeons have developed ways to minimize or virtually eliminate scarring.

3. There is a possibility of experiencing “shock loss,” which is the destruction of hair due to the trauma of the hair transplant surgery. Usually, this hair that is lost eventually grows back as your body recovers. However, in some cases, the hair is lost permanently. Just be aware of this risk. In order to avoid this, make sure you find a surgeon with very good Before & After photos and talk to several surgeons about the risk of you in particular experiencing shock loss. There are many successful hair transplant surgeries, so this may very well be fine for you, but it is also good to be aware of the possible risks.

The benefit of hair transplant surgery is that it involves using your own hair and there is no chance of losing that hair again, since the hair strands from the back of the head (which are moved to the places you lost your hair) will always be “immune” to hair loss caused by DHT.

The second option to gain back the hair you lost is via a method known as Hair Replacement, in which human hair (other than your own) is almost “grafted” into your scalp to provide a full head of hair. One example of a clinic that offers this solution is Graff Technology in Riverside, California. The benefit of this is that unlike in hair transplant surgery, there are no restrictions on how much hair you can use or what hairstyle you want to have, since there is a full supply of hair available. Also, you will have a full head of hair, giving a very natural look. And since there is no surgery involved, there are virtually no risks.

The downfall is that it requires maintenance and that it is not your own hair. However, if you want to have hair and cover up bald spots, this is an excellent and satisfying option.

Based on your stage of hair loss, you can choose to either do hair transplant surgery or the hairpiece. The hairpiece has no limitations as to what kind of hair you want, but it is not your own hair; the transplant surgery is limited by how much hair you have lost and how much you have available from your “donor site” (the sides and back of your head), but it uses your own hair, giving the most natural result.

“My hairline has just started to recede or my hair is starting to thin on the crown.”

If you have just noticed your hairline starting to recede (or it’s only been a few years since you started noticing hair loss), then you are still in excellent shape. This is because you likely still have a good portion of your hair on the top of your head, meaning all you have to do is strengthen and maintain the hair you have. In addition, some of the hair you have lost (in “bald” areas) may still be in a miniaturized state (not completely gone), which allows the possibility of reviving those weak hair follicles. It is much easier to deal with hair loss now than it would be if you were already mostly or completely bald.

lts-hairstyles.blogspot.com

For methods to slow down or stop hair loss and maintain the hair you currently have, see this post.

Another important thing is to try and predict how much at risk you are for further hair loss. Try to match up your pattern of hair loss with someone in your immediate or extended family (your dad or grandpa). Chances are (though it’s not a guarantee), you may have inherited a similar type and pattern of hair loss. This means you can use your dad or grandpa’s current hair situation as a predictor of the hair loss you will have to deal with. If Grandpa has no hair left except around his sides and back, then you can assume that will be the condition of your hair in the future if you do not do anything. Some people, on the other hand, only lose some of their hair. Knowing how much hair loss you would experience or what type of hair loss you will have to deal with can help in your procedure for maintaining your current hair.  Note: This is just a rough way of estimating, and is not necessarily guaranteed.  It may just help provide some perspective in your plan for treatment.

If your dad, grandpa, or uncle went bald at an early age, you may need to utilize the more powerful solutions (for example, a combination of the methods discussed here, the more powerful lasers with over 200 diodes, etc.) to maintain the hair you currently have. Image from http://www.gettyimages.com

If Grandpa is 70 years old and he’s only lost a little hair on the temples, you may not have to worry about your hair. In fact, you may just decide to let nature take its course. However, if Dad is 35 and his hair is almost gone, and you don’t want to go down that same path, then you need to watch your hair closely and take steps now to prevent future hair loss, perhaps using one or more of the solutions discussed above.

Since you have caught your hair loss in its early stages, you are in excellent shape and will have much better control of the situation. In short, the options you have for maintaining your current hair and stopping (or at least slowing) hair loss are finasteride or dutasteride, minoxidil, 2% ketoconazole shampoo, and low-level laser therapy.  I discuss the scientific studies behind these treatments here.

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* I am not a doctor. You should always consult a board-certified hair restoration doctor before making any decisions about hair loss treatments. However, from what I have researched, minoxidil’s effectiveness to reverse hair thinning at the crown seems to be better documented than it is for hair at the temples. In addition, minoxidil does not block DHT; it only stimulates hair growth, albeit in a somewhat mild manner.