According to the American Hair Loss Association, “American hair loss sufferers spend more than $3.5 billion a year in an attempt to treat their hair loss [as much as is spent for over-the-counter cold and flu treatments]. Unfortunately, 99 percent of all products being marketed in the less than ethical hair loss treatment industry are completely ineffective for the majority of those who use them.” As a result, the Association recommends “against purchasing any hair loss product that is not approved by the FDA or recommended by the American Hair Loss Association.”
The American Academy of Dermatology (AAD) recommends that hair loss should first be evaluated by your family physician or a dermatologist (specialists who treat the skin, hair, and nails). These physicians have the expertise and tools to help them “get to the root cause” (pun intended) of your hair loss—which could come from any number of medical, skin, hair, or even emotional disorders.
The reason to see a doctor early, as opposed to treating it on your own, is that the sooner you find the cause, the better your outcome. In other words, the less hair you have lost, the more successful legitimate treatments tend to be. Early treatment is by far the most effective.
The Huffington Post points out, “Hair loss, common for men and many women in midlife, can have profound emotional and psychological effects…. The phenomenon can be particularly devastating for [women]. ‘With men, hair loss in midlife is expected, and they can still be seen as attractive,’ says [Spencer] Kobren, [founder and president of the American Hair Loss Association], ‘But for a woman, it is over.’ This makes women especially vulnerable to all manner of hair loss ‘cures,’ and the possibility of spending lots of money, time, and emotional investment on ineffective treatments.”
I have also reviewed a lot of other dietary supplements, if you are interested, you might check them out.
There are two common forms of hair loss: hereditary baldness and diffuse hair loss.
Androgenic Alopecia (Hereditary Baldness)
In 2019, Prevention Magazine estimated that 80 million US adults experienced the most common type of hair loss, androgenic alopecia. It used to be called male-pattern baldness but is now called hereditary baldness as it affects an estimated 30 million women in the US.5 According to Mayo Clinic, the safest and most effective pharmaceutical medications to combat this type of hair loss are minoxidil and finasteride.
MINOXIDIL (Rogaine®) is an over-the-counter medication approved for men and women. It is rubbed into the scalp daily and is available in 2 percent and 5 percent liquid or foam. The 5 percent products are most often marketed to men, although women may safely use them as well. I recommend the 5 percent foam for two reasons: studies show that the 5 percent products are more effective and that the foam formulations are free of propylene glycol, which can cause skin irritation.
Robert Griffith, MD, of Alabama Dermatology Associates, advises, “There is also a small increased risk of irritation from the higher concentration, but most patients tolerate it well. At least six months of treatment is required to prevent further hair loss and to start hair regrowth. Only a small percentage of patients obtain clinically significant new growth, but the majority attain maintenance of their hair, which is an improvement as the condition is slowly progressive without any treatment.” It must be used indefinitely for continued support of existing hair follicles and the maintenance of any experienced hair regrowth.
FINASTERIDE (Propecia®, Proscar®) is a prescription drug approved for men that is taken as a pill. Over the first two years of use, up to 90 percent of men taking it experience a slowing of hair loss and improvement in hair thickening. About two-thirds show some new hair growth.8 It must also be used indefinitely and may not work as well for men over sixty years old. Finasteride comes in 1 mg and 5 mg tablets.
Multiple studies show the 1 mg dose is just as effective as 5 mg. Although higher-quality studies are needed, small trials suggest that finasteride may be more effective than minoxidil for the induction of hair growth. In addition, one small study suggested that combination therapy with finasteride and topical minoxidil may be superior to monotherapy with either agent; further study is needed to determine whether combination therapy should be routinely recommended.
However, the effect of finasteride on prostate cancer screening and sexual functioning should be discussed with your family physician. The FDA warns that pregnant women should not take it or even handle crushed or broken pills due to risk to their unborn baby.
Supplements for Hereditary Baldness
In animal studies, pumpkin seed oil (PSO) has been shown to increase hair growth. Natural Medicines rates PSO as “Possibly Effective” and “Possibly Safe” in treating hereditary baldness “based upon a study from South Korea which suggested taking a particular pumpkin seed oil (Octa Sabal Plus, Dreamplus Co. Ltd.). 400 mg daily in divided doses for 24 weeks increased hair count by 30 percent compared to placebo in men with mild to moderate hair loss. Self-rated improvement and satisfaction scores were 62 percent and 52 percent higher with PSO vs. placebo, respectively.”
Dr. Worthington reminds us, “Our ‘Possibly Effective’ rating does not mean that we would recommend these products, but that this product has some clinical evidence supporting its use for a specific indication; however, the evidence is limited by quantity, quality, or contradictory findings. These products might be beneficial but do not have enough high-quality evidence to recommend for most people.”
This product is not available in the US but may be available online (with all the associated risks of ordering natural medicines online). In addition, Octa Sabal Plus contained a variety of other ingredients that may stimulate hair growth, such as evening primrose oil and red clover—so there’s no way to know whether the PSO or the combination is what worked.
However, no PSO products are NMBER® rated greater than 7 out of 10 nor are any PSO products rated by ConsumerLab.com, Labdoor, or USP®.
According to ConsumerLab, “There is some very preliminary evidence that saw palmetto extract and beta-sitosterol may be beneficial in androgenic alopecia (hereditary baldness)—possibly by inhibiting the same enzyme (5-alpha-reductase) inhibited by the finasteride.”
Natural Medicines cautions, “The effects of saw palmetto when taken orally by patients with androgenic alopecia are inconsistent and unclear,” and “taking saw palmetto extract 320 mg daily for 24 months is less effective at improving hair growth in men with androgenic alopecia compared to taking finasteride 1 [one] mg daily.”
Natural Medicines also discusses the clinical research on “a combination of saw palmetto extract 200 mg plus beta-sitosterol 50 mg taken twice daily.” They report that this “improves subjective scores of hair quantity and quality in men with androgenic alopecia” and “some early clinical research shows that saw palmetto lotion applied topically twice daily for 50 weeks improves hair density by 27 percent in men and women with androgenic alopecia.”
However, an improvement of 13 percent was observed in the placebo group, and no between-group comparisons were made. Therefore, it is unclear if saw palmetto provided a statistically significant improvement compared to placebo.” Natural Medicines rates saw palmetto and beta-sitosterol as having “Insufficient Evidence” to rate for hereditary baldness.
Alopecia Areata and Diffuse Hair Loss
Alopecia areata is an autoimmune disease that most commonly leads to focal patches of hair loss. Diffuse hair loss that is not caused by autoimmune disease is a far more common form of hair loss in women and may be improved by the application of OTC minoxidil. Although minoxidil is not yet approved by the FDA for this problem, MedScape writes, “In those with extensive disease (50–99 percent hair loss), response rates vary from eight to forty-five percent.”
A number of other treatments are available from a dermatologist, although most generally have limited effectiveness. However, dermatologic breakthroughs are occurring quite often as our knowledge of hair loss expands. Your local dermatologist or family physician is the best information source for new research.
In the meantime, in the natural medicines’ realm, certain essential oils are sold to apply directly to the scalp. Natural Medicines rates two substances as “Possibly Safe” but with “insufficient reliable evidence to rate” for effectiveness when used topically in treating alopecia areata: Atlantic cedar and lavender.
They write, “There is some evidence that topically applying lavender oil in combination with the essential oils from thyme, rosemary, and Atlantic cedar (cedarwood) improves hair growth in up to 44 percent of patients after seven months of treatment.”
Other Supplements for Hair Growth
A number of other natural medicines are promoted for hair growth, including biotin (vitamin B7), coenzyme Q10, garlic, L-carnitine, raspberry ketone, red clover, rosemary, and thyme. Natural Medicines says there is “Insufficient Evidence” to rate any of these for hereditary baldness or alopecia areata.
ConsumerLab adds, “Cysteine and acetyl-cysteine supplements have been promoted for hair growth (typically 500 mg daily), although evidence for this use is not conclusive.” In addition, “Biotin is often included as an ingredient in supplements for hair and nails, but there is little evidence that it is helpful for hair loss.” They add, “A symptom of biotin deficiency is hair loss—although taking biotin if you are not deficient won’t help your hair.”
Medications That May Cause Hair Loss
To make a complex issue even more complicated, it’s important to know that a number of natural medicines are associated with the side effect of hair loss, including DHEA, selenium, St. John’s wort, vitamin A, and zinc. Also, there are a number of prescription medications that may lead to hair loss, including drugs used to treat gout, arthritis, depression, high blood pressure, and heart problems. Even the birth control pill has been linked to hair loss in some women.
The Bottom Line
When it comes to supplements and hair loss, I can’t recommend any of them as being both “Safe” and “Effective.” Furthermore, the traditional medications most often recommended are generally safe, somewhat effective, and reasonably priced. Generic prescription finasteride, for example, for men can often be purchased for under $10 per month (in some areas it’s as low as $3 per month), which is far less than any of these natural medicines. The OTC topical medication, minoxidil, used for men and women can be found for under $15 per month.