To date, the only two FDA approved hair loss treatments include Propecia (finasteride) and Rogaine (minoxidil). However, a number of alternative oral and topical products are marketed daily as effective hair regrowth solutions.  Though there is no question that marketing often over-reaches in order to sell a product, the real question balding men and women ask is, is there any proof that these products are effective in treating baldness?  What is the chance of regrowing hair?

Topical Hair Loss Products, Treatments and Cover Ups (Concealers)

For centuries men and women have been rubbing hair loss products including solutions, ointments, treatments and concoctions on their thinning hair in the hope of stimulating hair regrowth. In ancient Egypt it was popular to rub the fats of various animals, including lions, hippopotamuses, crocodiles, ibex, serpents and geese, onto the scalp as a hair loss cure.

Hippocrates had a personal interest in finding a treatment for baldness as he suffered from hair loss. He developed a number of different treatments, including a mixture of horseradish, cumin, pigeon droppings, and nettles to the scalp. These concoctions failed miserably and he became prominently bald. These and other treatments failures have continued to disappoint balding men and women.

Today’s Topicals - Snake Oils or Legitimate Hair Loss Products?

Today topical hair loss products such as special shampoos, conditioners, Rogaine, various scalp treatments, and cover up products can offer a potentially helpful adjunct to more effective and proven treatments such as Propecia (finasteride), Avodart (dutasteride), and or surgical hair restoration. However, many of the claims made by these topical treatments are unproven and even false.

What About Oral Hair Loss Treatments – Do They Work?

In addition to a multitude of topical hair loss treatments available, there’s an abundance of oral supplements that are conjectured to treat baldness.  Most oral solutions include ingredients that attempt to stop hair loss by inhibiting the production of DHT, the hormone responsible for androgenic alopecia (male pattern baldness).  However, much like topical treatments, very little proof exists for the majority of these claims.

Many products such as Provillus, Procerin, and Extreme Hair Therapy include both an oral and topical solution that attempt to stop hair loss at its source while working to stimulate hair follicles.  But how effective are these topical, oral and all-in-one solutions?

To learn more about various Topical Hair Loss Products, click below

DHT Blockers– These topical such as Revivogen, Crinagen, Progesterone Creams, and Xandrox claim to minimize the amount of dihydrotestosterone (DHT) present in the balding scalp. They are applied directly to the scalp.

Growth Stimulators- These topical solutions claim to work by stimulating hair growth. They include Rogaine, Tricomin, Folligen, Proxiphen (along with Prox-N and Nano Shampoo) and Retin-A.

Azelaic Acid– An active ingredient found in popular topical hair loss treatments such as Xandrox and Provillus conjectured to inhibit the production of DHT.

Superoxide Dismutase– These topicals such as Tricomin, Proxiphen, Proxiphen-N and Folligen, claim to stop hair loss by reducing Super Oxide and also stimulating hair growth and reducing tissue inflammation.

Anti-Inflammatories- These anti-inflammatory treatments claim to reduce itching, flaking, redness, and inflammation that may increase hair loss. These topical treatment options include Tricomin, Folligen, Proxiphen and Proxiphen-N, Betadine and T-Gel and Nizoral Shampoo.

Cover Ups / Concealers- Topically applied scalp/hair cover ups like Toppik, Prothik, and Couvré can do a surprisingly good job of masking and minimizing a person’s appearance of being bald. These topical concealers and “cover ups” act by reducing the contrast between a hair loss sufferer’s thinning hair and balding scalp, while increasing the volume and fullness of the thinning hair.

Rogaine (Minoxidil)) – Applied twice daily to the balding areas, this treatment has only been shown to work in the crown (back of the head). It is the only topical treatment for hair loss that is FDA approved.

Propecia (Finasteride)– An FDA approved oral hair loss solution proven to inhibit the production of DHT, the hormone responsible for genetic male pattern baldness (MPB).

Provillus– A popular oral and topical solution containing FDA approved hair regrowth solution minoxidil and a number of all-natural ingredients that supposedly inhibit the production of DHT

Saw Palmetto– A popular herbal treatment contained in many marketed hair loss products including but not limited to Provillus, Procerin, and Extreme Hair Therapy (EXT)

Extreme Hair Therapy (EXT) – A nonsurgical 5 step hair loss treatment process provided by Hair Club

Xandrox– Topical hair loss solution containing azelaic acid and FDA approved hair regrowth solution minoxidil

Revivogen– Topical hair loss solution containing a number of all natural ingredients said to inhibit the production of DHT

Crinagen – A topical spray containing ingredients said to inhibit the production of DHT

Progesterone– A synthetic form of the female hormone progesterone that has been used to treat female hair loss

TRX2- TRX2 is marketed to hair loss suffering men and women and claims to help promote and sustain healthy hair growth through potassium channels.

To learn more about these and other treatments, see what real patients are saying about them on our hair loss forum.

Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.

While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.

The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.

How our member physicians use the Lateral Slit Technique.

Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.

The graft incision determines the direction of the hair growth

The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.

Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.

Lateral slits can enable denser packing of grafts

Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.

In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.

The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.

Placing grafts to maximize their aesthetic result and coverage

The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.

Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.

Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.

Nizoral 2% is magnificent shampoo and a significant part of what's referred to commonly as the Big 3. The other two are the FDA approved and proven treatments Propecia (finasteride)and Rogaine (minoxidil). To date, Nizoral is the only shampoo on the market that can make the unique claim that it's proven to stop the formation of DHT. Its active ingredient ketoconazoleat 2% concentration has proven to be a moderate DHT inhibitor and has growth stimulating properties about as effective as Rogaine 2%.

This product includes 2%, the highest concentration of the active ingredient ketoconazole. To view the clinical abstract proving the effectiveness of ketoconazole in the treatment of androgenetic alopecia, view "Ketoconazole as a hair loss treatment". There is also a less concentrated 1% of Nizoral. To learn more, visit Nizoral regular shampoo.

We strongly suggest using Nizoral shampoo in addition to other proven treatments. Nizoral should be used 2 or 3 times a week to avoid dry hair and a flakey scalp.

On the off days, you may want to consider rotating Nizoral with other excellent shampoos designed specifically for thinning hair. See the recommended treatments section below for other shampoos we recommend.

Developing Realistic Expectations:

Men and women sometimes suffer from hair loss for different reasons. Thus, diagnosing its cause is necessary to facilitate and promote proper treatment.

Don't expect immediate results. It's recommended to use Nizoral in conjunction with other proven treatments for at least 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you determine whether or not Nizoral has been successful in helping you maintain existing hair.

To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultation with one of our prescreened hair restoration physicians.

The "Active" Ingredient in Many Popular Hair Loss Treatment Products

Many popular hair loss treatment options today such as Provillus, Procerin, and Avacor contain the “active” ingredient saw palmetto. It can also be purchased as a standalone supplement in most nutritional stores. But the age old question of whether or not it can effectively treat baldness in men and women with alopecia is still heavily debated. By taking a look at the scientific evidence available we are able to draw some conclusions as to its potential benefit for those with thinning hair.

What is Saw Palmetto?

Saw Palmetto berries are a deep red fruit that grow wild on palm trees in warmer climates, typically found in the Southeastern United States. The liposerolic berry extract is typically used as an herbal supplement for the promotion of a healthy prostate.

Saw Palmetto Hair Loss Study:

Similarly to finasteride (the active ingredient in Propecia and Proscar), studies have shown that when taken orally, it may be an effective anti-androgen by lowering dihydrotestosterone (DHT) levels in the body by blocking 5 alpha-reductase enzymes. Additionally it is said to block receptor cites on cells which is required for cells to absorb DHT.

Tests have also been performed on its use in the treatment of benign prostatic disease, which similarly to androgenic alopecia, depends on the production of DHT.

It is also noteworthy to state that a small preliminary study in 2002 was performed as reported by The Journal of Alternative and Complementary Medicine(2002;8:143-52) that shows a select group of 19 men between the ages of 23 and 64 taking either (400mg of saw palmetto and 100mg of Beta-sitosterol) or a placebo orally. Those who took the herbal combination had 60% improved hair growth over those who took the placebo. There have been no studies to date indicating the efficacy of saw palmetto applied topically for male pattern baldness, female hair loss, or anything to date.

In our opinion, there are two potential difficulties with this study:

• Many scientists would argue that the control study group was too small to determine any real efficacy and improved hair growth could have happened by chance. A larger study therefore may be necessary to determine any level of real efficacy.
• “Improved hair growth” is not the same thing as newhair growth and hair regrowth, nor should it necessarily imply that it works to stop hair loss
• There are no regulations or suggested daily value as to how much saw palmetto would be required to successfully treat baldness. The appropriate dosage therefore is questionable.
• The above study was only performed on saw palmetto taken orally. Hair loss products that promote topical use for baldness are basing their belief in its efficacy on something other than published clinical evidence.

The Dosage:

But if there are no current standards on dosages of herbal medications in the United States, how do these popular hair loss treatments produce an appropriate dosage?

Clinical studies on Benign Prostrate Hyperplasia (BPH) have used a dosage of 320mg of the berry extract daily (either one 320mg pill or 2 X 160 mg pill). A daily dosage of 480 mg of saw palmetto berry extract was not found to be any more effective in a six-month study. If the entire berry was used, up to 1000mg or 2000mg would be required to reach the same goal.

The theory therefore is that if saw palmetto can successfully treat an enlarged prostate similarly to finasteride, it can effectively treat hair loss with a similar dosage Many popular “baldness cure” products contain approximately 1500mg of the berry which is equivalent to approximately 240-320mg of the berry extract.

Side Effects and Warnings:

One false assumption is that “all natural” treatments don’t have potential side effects. It is stated that use of saw palmetto has not proven to be safe for women with hair loss during pregnancy and lactation. Medical supervision is suggested for women of childbearing age. Similar warnings are listed about Propecia.

Conclusions:

Based on some anecdotal evidence, saw palmetto is said to treat baldness because of its tendency to act like finasteride by helping those suffering from BPH. However, authentic clinical studies have not been performed to date that support this claim. Dosage and how it should be used (orally or topically) therefore is based on conjecture rather that scientific evidence.

Today hair loss sufferers have several legitimate and proven treatments for restoring their hair.

Over the past decade in particular, treatments for hair loss have made huge advances. Hair loss medication like Propecia (finasteride), Avodart (dutasteride), and to a lesser degree topical treatments like Rogaine often can stop or even reverse hair loss in most people.

However, neither Propecia nor Rogaine has been proven to restore hair in the frontal areas. Only hair restoration surgery has been successful in restoring hair in the frontal hairline area once it has been lost.

Done right, hair transplants are so natural that even a hair stylist cannot detect that a person has had a hair transplant. The days of the “corn row” or “Barbie doll” hair transplant are long gone.

Hair replacement systems or “hair systems” have also improved and become more refined. Those who are extensively bald and want to restore a full looking head of hair may find a hair replacement system to be appropriate.

There are also topicals, such as sprays and applications, which can do a surprisingly effective job of giving a person the appearance of having a much fuller head of hair.

Future hair loss treatments also hold the promise of making baldness a disease of the past.

Despite attempts by the FDA to regulate the promotion of hair loss products, balding men and women still need to be wary of the many questionable treatments that are often heavily advertised.

Each hair loss treatment has its advantages and disadvantages. We believe in empowering you with the tools and assistance to explore and evaluate all your treatment options. Ultimately the best hair loss treatment is the one that works best for you.

We encourage you to take your time and explore all your options before committing to any hair loss treatment.

Explore this and other web sites and compare notes with other hair loss sufferers about what does or does not work.

Our hair restoration discussion forum has over 180,000 searchable postings by other hair loss sufferers.

If you post your question or concern, typically several people will reply with helpful advice and suggestions.

To get expert medical advice and review all your hair loss treatment options, consider doing a free consultation with one of our quality member physicians.

To learn about our physicians, or to arrange a consultation, visit our physician finder.