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.

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.