Stop Your Hair Loss

In detail

Hair coming out all over, two or three months after a fever, an operation, a crash diet or a hard stretch, is probably shedding. It usually settles by itself once the trigger has passed.

Found

Usually settles by itself. A review of the condition: this shedding is one of the most common causes of thinning all over the scalp, and it usually settles by itself. Stress is felt to be its most common trigger.

Why

A shock tips many follicles into their resting phase at once. They drop their hairs together a few months later. When the body settles, the follicles start growing again.

Watch

Shedding that runs past six months, or a thinning pattern under it: a doctor.

In detail

List every medicine and supplement you started in the months before the loss. Testosterone or anabolic steroids can bring pattern loss on. Never stop a prescribed medicine on your own.

Found

Hair loss, a listed risk. A review of testosterone taken for muscle and strength: the health risks it names are liver toxicity, breast growth and hair loss.

Why

Testosterone is the raw material for DHT, the hormone that shrinks follicles on a scalp built to lose hair. More testosterone means more DHT at the follicle. Some medicines stop hair growing until they are stopped.

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Stopping a prescribed medicine suddenly can cause serious side effects. Ask first.

In detail

Take the first photo set tonight and the same set every three months. Same room, same light, same distance, hair dry, the phone under a stat. The hairline from the front, the crown from above.

Found

A standard for hair photos: position, lighting, pose and technique vary so much that most photos cannot be compared. The standard sets nine fixed views, taken the same way every time.

Why

Hair changes too slowly to see in a mirror. A fixed photo is the only fair comparison with where you started, and it is how the hair trials judge the result too.

In detail

The 5% solution or foam, twice a day on a dry scalp, from the week you notice thinning. Sold without a prescription. With the finasteride, and for as long as you want the hair. Stop, and the new hair goes inside months.

Found

45% more regrowth at 5% than 2%. Forty-eight weeks, 393 people: 5% beat 2% and placebo on hair count and on what the man saw in the mirror, with 45% more regrowth than 2%. Pooled trials: 2.3 times as likely to show visible growth on the investigator’s rating.

Why

The scalp enzyme sulfates it into its active form, which opens potassium channels, widens the follicle's blood supply and extends the growth phase. The enzyme varies between scalps, which is why the response varies from man to man.

Watch

Scalp irritation and itch, more at 5%. A shed in the first two months, which is the old hairs leaving. Stop it and the gain goes. Ask a doctor first if you have heart disease. Keep it away from cats: a few drops can make a cat critically ill.

The deep dive on this

In detail

A 2% ketoconazole shampoo a few times a week, the lather left on for a few minutes before you rinse. In the US the 2% strength is prescription only and 1% is sold over the counter. Beside the drugs, not instead of them.

Found

Density and size up. In a long-term comparison against 2% minoxidil, the 2% shampoo improved hair density, hair size and the share of growing follicles almost as much. A review of five human studies, 318 people, found thicker hair shafts.

Why

Ketoconazole kills the scalp yeast behind a low-grade inflammation around the follicle, and it calms inflammation on its own. In the trial it also cut the oil on the scalp.

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Scalp dryness or irritation.

In detail

Rosemary oil rubbed into the scalp nightly, six months before you judge it. Never swallowed.

Found

hair count up at 6 months. Six months, 100 people, against 2% minoxidil: hair count up in both groups at six months, and the rosemary scalp itched less.

Why

Its terpenes widen the small vessels around the follicle, the same lever minoxidil pulls with a drug. Route decides everything: on the scalp it is a tonic, by mouth an essential oil is a poison.

Watch

Scalp irritation. Never by mouth.

The deep dive on this

In detail

A red-light cap, helmet or comb on the scalp, on the schedule its own trial ran, for four to twenty-six weeks before you judge it. Beside the drugs, or for the man who will not take them.

Found

Large effect after 20 weeks. Thirty-eight studies, 3,098 people: hair density up against a fake treatment light, a large effect before 20 weeks and a larger one after. A 24-week home-helmet trial against a fake treatment helmet: density and hair diameter both up.

Why

Red and near-infrared light is absorbed by an enzyme in the mitochondria and briefly lifts a brake on the cell’s energy output. In the follicle that reads as a longer growth phase.

Watch

Never into the eyes. The beam that grows hair injures a retina. A short shed and an itchy scalp were the side effects reported.

The deep dive on this

In detail

An adenosine lotion on the thinning scalp twice a day, beside the minoxidil. The pooled trials used 0.75%. Expect thicker hairs before you expect more of them. Judge it at six months.

Found

Seven trials of adenosine lotion or shampoo: every one reported less hair loss and more density. In a 6-month placebo trial, the share of thick hairs rose, fine hairs fell, and density rose against placebo.

Why

Adenosine docks on receptors in the dermal papilla, the cells at the base of the follicle that set how thick a hair grows. They answer with growth factors that keep the follicle building and feed it more blood.

Watch

Scalp irritation. A short shed when you start.

The deep dive on this

In detail

The low-dose pill, prescribed off-label for hair, for the man the foam did not suit. The consensus start is 2.5 mg a day, within 1.25 to 5 mg. Blood pressure, weight and heart history are checked first.

Found

+47 hairs per cm² per mg a day. Six studies, meta-regression: each extra milligram a day added 47 hairs per square centimeter and 1.4 microns of shaft at six months, 18 points of hypertrichosis risk and 4.8 points of cardiovascular side effects. A review: unwanted hair in 24%, an early shed in 16 to 22%, mild swelling in 2%, pericardial effusion rare at hair doses.

Why

Minoxidil is switched on by an enzyme in the follicle. It opens potassium channels that widen the blood supply and hold the growth phase. Swallowed, it sends the signal to every follicle on the body. That is how it works and the side effect in one.

Watch

Unwanted hair on the face and body in about a quarter. An early shed in 16 to 22%. Fluid swelling in about 2%. Cardiovascular side effects rise with the dose. Pericardial effusion, fluid around the heart, is rare at hair doses. Not with pericardial disease or uncontrolled blood pressure.

The deep dive on this

In detail

Microneedling on the thinning area once a week, on top of 5% minoxidil twice a day. With a dermatologist, or on one’s advice, with a device made for the scalp.

Found

A review of twelve trials, 631 people: microneedling plus minoxidil grew more hair, and thicker hair, than minoxidil alone. Side effects were mild or passed on their own. In eight pooled trials, every one showed a higher hair count on the combination.

Why

The tiny wounds set off the skin’s repair signals and growth factors around the follicle. They may also let more minoxidil into the scalp.

Watch

Redness and soreness for a day or two. A red, infected or inflamed scalp is a reason to wait.

In detail

Medical tattooing of tiny dots that read as cut stubble, for the man whose goal is to look fuller. Three weekly sessions and a touch-up a month later, in a medically supervised setting. It changes how the scalp looks, not the hair.

Found

A series of 22 people: three weekly sessions and a touch-up a month later. Over a mean of 20 months fading was minimal, there was one allergic reaction and no serious complications.

Why

Thinning shows because pale scalp shows between the hairs. Pigment dots in the upper skin close that contrast, so the hair that is there reads as denser.

Watch

An allergic reaction to the pigment is possible.

In detail

A growth-factor serum with bFGF, added once 5% minoxidil twice a day is a habit. On top of the minoxidil, never instead of it.

Found

A trial of 80 people: bFGF plus 5% minoxidil worked better than 5% minoxidil alone at 3 and 6 months, with more satisfaction. In a network of trials, PRP plus bFGF plus minoxidil ranked first, 35.12 more hairs per square centimeter than minoxidil alone.

Why

It is a lab-made copy of basic fibroblast growth factor. It grips receptors on the dermal papilla at the base of the follicle and pushes resting follicles back into their growth phase.

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Irritation where it goes on.

The deep dive on this

In detail

A caffeine scalp serum or shampoo worked in daily, beside the minoxidil. Judge it on what is in the shower drain, over six months.

Found

Nine trials, 684 people: every one concluded in favor of topical caffeine, though most were small or had no placebo group. In a 24-week placebo trial of 154 people, a shampoo of caffeine with dimethylglycine (DMG-Na) cut the hairs that came out on a pull test.

Why

Caffeine blocks phosphodiesterase, the enzyme in follicle cells that breaks down cyclic AMP, the messenger that keeps a follicle growing. In follicles kept alive in a dish, it cancels the shrinking DHT causes.

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Scalp irritation, and dryness from alcohol-based lotions.

The deep dive on this

In detail

Pumpkin seed oil capsules, 400 mg a day, for 24 weeks, beside the main drugs. The one trial used a capsule, not oil on the scalp.

Found

A 24-week placebo trial of 76 people: hair counts rose 40% on the oil against 10% on placebo. Self-rated improvement was higher, and side effects did not differ.

Why

In the lab, pumpkin seed oil blocks 5-alpha-reductase, the enzyme finasteride blocks, and has anti-androgen effects. The proposed route is less DHT at the follicle.

Watch

Side effects in the trial were no different from placebo.

In detail

Saw palmetto extract, 320 mg a day by mouth, the 2-year trial’s dose, beside the main drugs or before you start them. The pooled studies used 100 to 320 mg, by mouth or on the scalp. Judge it at a year, on the standard photo.

Found

Five trials and two long-term studies, by mouth and on the scalp at 100 to 320 mg: total hair count rose 27% and density rose in 83.3%. In a 2-year trial of 100 people, 320 mg a day improved pattern loss, most at the crown.

Why

Saw palmetto blocks 5-alpha-reductase, the enzyme finasteride blocks, more gently. Less of it means less DHT at the follicle, the hormone that shrinks it.

Watch

Mild stomach upset. It can lower sex drive and change ejaculation. It can lower a PSA reading: tell the doctor you take it before a PSA test. It may raise bleeding risk: on a blood thinner, or before surgery, ask first. Rare liver and pancreas problems have been reported: stop at yellow eyes or skin, or severe stomach pain.

The deep dive on this

In detail

Mixed tocotrienol capsules, 100 mg a day, for 8 months, the trial’s dose and length, beside the main drugs.

Found

An 8-month placebo trial, 21 on the capsules and 17 on placebo: hair number rose 34.5% on tocotrienols against a 0.1% fall on placebo.

Why

Tocotrienols are strong antioxidants from the vitamin E family. A scalp losing hair carries more oxidative stress, and cutting it is the proposed route.

Watch

Stomach upset in some. It may raise bleeding risk: on a blood thinner, or before surgery, ask first. Triglycerides rose in some studies: if yours are high, recheck them.

The deep dive on this

In detail

A 1% procyanidin B-2 scalp tonic, the apple compound, used daily for 4 months as the trial ran it, beside the main drugs.

Found

A 4-month trial of 29 people: total hair count in the test patch rose on a 1% procyanidin B-2 tonic and fell on placebo. More hairs grew thicker than 40 microns, and 78.9% saw thicker hair on average against 30.0%.

Why

Procyanidin B-2, found in apples, pushes hair-root cells to grow in the lab. On the scalp, the proposed route is a longer growing phase.

Watch

No side effects were seen in the trial. Stop if the scalp turns red, itchy or sore.

The deep dive on this

In detail

One milligram a day, the tablet approved for male-pattern hair loss, on a prescription. Start the year you notice the hairline or the crown move, and take it for as long as you want the hair. A PSA on file before dose one.

Found

1,553 people; loss slowed at 1 mg. Two one-year trials, 1,553 people, extended to two: 1 mg a day slowed the loss and grew hair by every measure. The dose-ranging trials: 0.2 mg works, and 1 and 5 mg work the same. Fifteen placebo trials, 4,495 people: sexual dysfunction at 1.66 times the placebo rate on finasteride.

Why

It blocks type 2 5-alpha-reductase, the enzyme that makes DHT from testosterone. DHT is what shrinks the follicle on a scalp built to lose hair. Lowering DHT is the whole of how it works, on the scalp and everywhere else it acts.

Watch

Sexual dysfunction at 1.66 times the placebo rate, and on the label, sexual problems that continued after stopping. Report any breast lump, pain or nipple discharge promptly. The label warns this drug class may raise the risk of high-grade prostate cancer. Suicidal thoughts are a confirmed side effect: any mood change, stop and call the doctor. It lowers the PSA, so the baseline goes on file first. Never handled by a pregnant partner.

The deep dive on this

In detail

A stronger blocker of the same hormone, 0.5 mg a day, to ask a doctor about when finasteride has not held the hair. In the US it is licensed for the prostate and prescribed off-label for hair. Japan approves it for hair loss.

Found

Beat finasteride 1 mg at 24 weeks. 917 people, 24 weeks: hair count and width rose with the dose, and 0.5 mg beat finasteride 1 mg on count, width and the frontal photos. Three head-to-head trials, 576 people: more hair than finasteride, with similar sexual side effects.

Why

DHT is made by two forms of the enzyme. Finasteride blocks one, dutasteride blocks both, so DHT falls further in the scalp and the blood.

Watch

Sexual side effects at rates like finasteride’s. The label warns it may raise the risk of high-grade prostate cancer. It lowers the PSA too, so the baseline goes on file first.

In detail

Finasteride as a scalp spray, for the man who wants the drug with less of it in his blood. Ask a dermatologist. In the EU a finasteride skin spray is authorized for mild to moderate pattern loss. The US has no approved topical form, and its regulator has warned about compounded ones.

Found

20.2 hairs against 6.7. 458 people, 24 weeks: hair count up 20.2 hairs against 6.7 on placebo, and about level with the tablet. Blood DHT fell 34.5% against 55.6% on the tablet, and peak drug levels in the blood were over 100 times lower. Across the pooled trials, sexual side effects came in 2.8% on the 0.25% spray against 4.8% on the tablet.

Why

On the scalp, the drug blocks DHT where the follicle is. Less reaches the blood, so the rest of the body keeps more of its DHT.

Watch

Sexual side effects in 2.8% on the spray against 4.8% on the tablet, and some have lasted after stopping. The label says to see the doctor about any low mood or other psychiatric symptom. Report any breast change promptly: a lump, pain, swelling or nipple discharge. There are no data yet on its effect on the PSA, so tell the doctor you use it before a PSA test. It is not for women. A woman who is or may become pregnant, and anyone under 18, should not touch the spray, the treated scalp or anything it has reached. If they do, wash the area well.

In detail

Your own blood, spun down in a clinic, and the plasma rich in platelets placed into the thinning scalp by a doctor. A course at first, then top-ups. Beside the drugs.

Found

Density up at 3 and 6 months. Nine trials, 238 people: hair density up at 3 and 6 months against placebo, with no serious side effects. In a network of 27 trials, 1,110 people, PRP added to 5% minoxidil ranked above minoxidil alone.

Why

Platelets carry growth factors. Concentrated and placed at the follicle, they are thought to push it into its growth phase and keep it there.

Watch

Pain, swelling, bruising or redness where it goes in, for a day or two.

In detail

Once the loss is steady on the drugs, a consultation with a hair-restoration surgeon. Follicles are moved from the back of the head to the thin areas. Keep the drugs going after, for the hair that was not moved.

Found

Your own follicles, moved. Follicular unit excision takes single follicle groups from the back of the scalp with a small punch and moves them into the areas of loss. In a before-and-after study, self-esteem and quality of life were both better after the surgery.

Why

Follicles at the back and sides are built to ignore DHT, and they keep that trait when moved. The moved hair lasts. The hair around it still needs the drugs.

Watch

It is surgery: swelling, scabbing and a healing period. It moves hair rather than making more, so the donor supply sets the limit.