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.

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.

“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.