Thinning/thin hair, short/shortening terminal length ("hair won't grow")? Check here!

[Reyesuela]

A Healthy Diet

A healthy diet has enough "good" carbs, fat, and protein and limits the "bad." It also has plenty of all the needed micronutrients. You can evaluate your macronutrients (carbs, fat, and protein) on MyFitnessPal for free, or your micronutriens on Cronometer for free--it's slightly more of a pain to use. Weight your food, or it's completely worthless. Even packaged food. I'm serious! Otherwise, your estimates will be wildly wrong.

Good Carbs: 50-70% of Calories

Vegetables: 5-10 servings a day

The largest source of high-quality carbs in your diet should be culinary vegetables. Five a day is good. Ten a day is better. Eat "across the rainbow" for the best health. I've spent a long time with nutrition tables, and I've got a simple formula that I try to get every day to hit all the micronutrients without weighing my food every single day.

-Dark leafy greens and cabbage family. Salad or cooked, doesn't matter. At least one serving. Also includes broccoli.
-Orange, dark yellow, or red vegetable. I try to get a serving of these, whether tomatoes, sweet potatoes, squash, red peppers, or carrots.
-Onion family. Some onions/leeks/garlic every day. I eat less than a full serving, almost always, but I put a decent amount inside one or more dishes!
-Starchy vegetable. Yes, potatoes are healthy! Just don't fry them or drown them in butter. I usually get one serving of some kind of starchy veg. These have lots of soluble fiber.
-Beans and Peas. Together with whole grains, these are lower-methionine sources of protein as well as high-quality carbs.
-Other Veg to Watch: While not daily, necessarily, it's very good to have peppers, seaweed, and cooked mushrooms. (Raw mushrooms are not very healthy at all, though.)

Whole Grains: 2-5 servings a day

I love whole grains, but I try to limit myself to make more room for veg! 2-5 servings a day is ideal, with higher numbers mostly for active men who are eating more calories.

Whole grains include oats, rye, wheat, and barley, among others. Sweet corn, not so much, but cornmeal, especially masa, yes. They have very high protein for plant-based foods. Unless you have an allergy or celiac disease, there is no reason to avoid wheat. Gluten today is the same as gluten 150 years ago. The "wheat belly" author flatly lied. People have been eating high-starch foods from the beginning of time. Where grass seeds weren't a staple, starchy roots were. Whole grains are closely associated with good insulin sensitivity and low levels of heart disease, especially those types affected by atherosclerosis.

Oats are especially good for hair, and whole wheat and barley have high silica content--also hair-boosters.

Fruit: 3-5 servings a day

Eating across the rainbow also applies to fruit! Culinary fruit can be divided largely by color. I try to eat an orange/yellow citrus fruit, a red or purple berry serving, and one other fruit, often apples, each day, minimum. Fruit is high sugar, but in the whole form, it has enough fiber that it doesn't have a negative impact on a healthy person's blood sugar, and fruit has many micronutrients that are either unique to fruit or not really found elsewhere. Whole fruits are always better than juice. Juice is more like sugar water with vitamins thrown in!

As far as hair goes, these carbs are going to be the major source of antioxidants for your body, including vitamins A, C, and E, as well as some trace minerals like silica.

Fermentation: Healthy Booster

A number of fermented foods have been shown to have really positive health effects that are unique to fermentation.

Bad Carbs

Added sugars, including natural sugars like agave nectar and honey, fruit juice, and refined grains do not have the health benefits of good carbs and are implicated in atherosclerosis and insulin insensitivity. Keep under 2 servings of refined grains of any type and under and under 6 teaspoons--preferably half that--of added sugars.

[Reyesuela]

Fats: 15-30%

Low fat diets destroy hair, but the wrong kinds of fats won't do you any favors, either.

True olive oil is the single best-documented fat for beneficial health effects. As much as possible, added oils and fats should come from olive oil. You can cook with it and garnish with it. Sadly, almost all the oil that is imported is adulterated due to the massive influence of organized crime in Europe. Buy certified California-grown olive oil instead. I buy a big bottle right after harvest and stash it in my deep freeze, unfreezing it to refill a smaller bottle so it doesn't oxidize much throughout the year. Other decent fats include naturally-occurring fats in fruits like avocado and also peanut and canola oils.

Fatty fish are the main source for healthy dietary omega-3 fats that the body can use. While flaxseed is great for other reasons, you can't actually use the ALA omega-3 from plant sources with any efficiency. Fish are where it's at. If you don't want to eat animal-derived products for ethical reasons, try algal oil that contains DHA and EPA.

Nuts are an excellent source of healthy fats. Many studies have specifically linked the consumption of 1-2 servings (moderate handfuls) of nuts a day to good heart health.

Monounsaturated animal fats are also fine in moderation.

Bad Fats

Saturated fats are not fine! Despite the recent hype, yes, saturated fats are clearly bad for you, even when they come from grassfed beef or butter. Limit these severely--red meats to 2 servings or less a week, and butter the same. Dairy products that are part skim are better than full fat, and cheese with fat should be limited also because of high levels of advance glycation end products (AGEs).

Palm oil is possibly even worse than red meat fat. The benefits of eating, not spreading on hair/skin, of coconut oil is primarily documented in contrast to palm oil. Coconut oil versus olive, peanut, or canola oil does not yet have any documented benefit, but it's definitely a smart choice over butter or palm oil!

Frying, including deep frying or pan frying, makes even healthy oils far less healthy and causes AGEs to form at extremely high rates.

Protein: 10-20% of calories

Adequate protein is crucial for hair growth, as hair is made of protein, and protein sources are also the best sources for most B vitamins and many trace minerals. A diet should be lower in protein if you are younger and less active. If you are highly active and young, 15% is good. If you are over 65, 15-20% is best because people stop absorbing protein as well, regardless of activity level.

Protein from plant sources should ideally be at least half of all your protein. Many meats are pro-inflammatory, and the amino acid mix from plant sources are less aging than animal sources. Aging is bad for hair! The remainder of protein can come from animal sources, ideally the following:

Seafood, Especially Fatty Fish: 2+ servings per week

Fatty fish twice a week and as much other seafood as fits your diets are good for the body and hair. Don't eat high-PCB and mercury fish more than once a week, though.

Dairy: 1-3 servings a day

Dairy is still the best dietary source for bio-available calcium--and calcium supplements have all kinds of health issues associated with them, so dietary sources are far, far better. Low-sugar dairy, such as kefir, unsweetened yogurt, and fresh cheeses are best, especially if they are also skim or part-skim. At least one serving a day is needed even with lots of calcium-rich other foods, unless you are eating lots of fish with bones (as some people do with anchovies canned sardines and salmon).

Lean White Meats

Poultry is a healthy source of many amino acids and trace elements.

Eggs: Up to 5 a week

Up to five eggs a week is still shown to be healthy! Eggland's Best or pastured eggs are healthier than conventional. Organic doesn't matter.

Gelatin

Gelatin and broth/stock made with animal skin are an important source of amino acids that tend to be in short supply in modern diets that are incredibly important for hair-building. You can take these however, but I stick with caplets because I just don't like gelatin all that much, and I don't eat yogurt fast enough to keep it from gelling unpleasantly with pure gelatin. 3g a day is a great goal. This has been shown in numerous studies to increase hair.

Bad Protein

Preserved Sausage and Deli Meats

These are class 1 carcinogens. They have a weak effect, but limit them to once a week! They are very pro-inflammatory. Not good for hair.

Red Meat

Eat lean cuts of red meat no more than twice a week. Even grassfed beef and wild game has unhealthy fats. The added amounts of omega-3, monounsaturated, and CLA are very, very negligible, unfortunately, and don't offset the effect of the saturated fat.

[*Wednesday*]

What is maybe important to add is, that thinning is normal after having had a baby: see, post-partum hairloss.

Also, if you notice thinning, just don't go to the store and start smearing all sorts of things on your head, go to your doctor first and have a basic bloodtest done to look for deficiencies or potential health risks.

That is a good mention. If all is okay, then we can smear

[Reyesuela]

That is a good mention. If all is okay, then we can smear

LOL! If you have hair loss that is really dramatic or is part of other symptoms, you should definitely see a doctor! Hair loss plus hair where you don't want it, hair loss plus fatigue, hair loss plus aching gums, hair loss plus dramatic weight loss--those might be signs of something serious.

Plus, everyone should ALREADY KNOW their vitamin D and fasting/postprandial blood sugar levels. Right? Right?

[lapushka]

Smoking

Smoking kills hair follicles over time and also turns your hair gray. As if you need another reason to quit! QUIT!

Smoking might not be as "hip" as it was in the 50s, and 60s and 70s, but my mom and dad have both smoked their entire lives (they are both in their 70s now), and my dad has gone gray very gradually (still isn't fully gray), and my mom was gray by age 40-45. Is there any proof (study) out there that confirms this?

[Reyesuela]

Your Hair is Thinning! What Will the Doctor Do?

What the doctor does depends on finding other than hair thinning. In general, he will probably order a basic metabolic panel.

Poor fasting glucose levels indicate insulin resistance. Most people's fasting glucose gets worse with time. This is partly aging but heavily accumulated damage due to sedentary lifestyle, poor diet, and increasing fat mass with decreasing muscle mass due mostly to the two things before. 70-99 mg/dl is considered normal. (If you're in a country that reports in mmol/L, divide everything by 18.) But below 85 is best--this "high normal" includes 85-year-olds, and unless you're 85, you shouldn't be getting these numbers. High-normal to low-high fasting glucose isn't treated medically, but exercise and diet changes should do the trick. Metformin is usually the frontline treatment for higher levels--but lifestyle changes are still important. Start with a microdose with a pill cutter to avoid extreme nausea, if your doctor lets you. If you ramp up slowly, it's very well tolerated. The initial nausea stage makes most people stop taking it.

A high BUN/creatine ratio is also associated with hair loss since it can indicate blood flow issues that come with heart disease. (Don't freak out--it also comes with dehydration!)

You may also get a lipid panel. High cholesterol is associated with hair loss because your skin can manufacture androgens locally from cholesterol.

You should get a serum ferritin test. Low ferritin causes hair loss. Typical results are 15-200 ng/ml for women and 20-300 ng/ml for men. Above 100 ng/ml has been shown to be highly associated with heart disease and is believed to CAUSE it. Therefore, the ideal range is considered to be 25-75 ng/ml for both men and women. Some people really want their serum ferritin above 50 ng/ml because they think it improves hair. Fine, but keep it BELOW 75 ng/ml. If your iron is low, you'll be prescribed iron. If it's high, donate blood! Many doctors don't know about the ferritin/hair loss link, so you may need to push for this, but you should be getting this anyway because of the extremely damaging effects of high ferritin!!!!

You should already be getting vitamin D tests regularly and should be on a supplement. Vitamin D is manufactured in the skin with exposure to UV radiation and can't be gotten through food. Almost no one with an indoor job gets enough sun exposure to get enough vitamin D, and no one does in the winter in moderate to cold climates. People with darker skin are especially prone to get deficiencies. So basically practically everyone is deficient at least part of the year. The Vitamin D Council recommends that adults take 5000 UI of Vitamin D daily so that you have a low chance of being deficient or having too much. The healthiest range is 40-80 ng/ml or 100-200 nmol/l. Vitamin D3 is the only usable form of vitamin D.

If you present with fatigue or with sudden weight loss or you are quite slim, your doctor is likely to order a check of your thyroid hormone levels. There is some debate as to what the low cutoff should be because some people with low-normal thyroid hormone levels feel better with higher levels. There are very long articles written on this. I'm staying out!

If you are a woman presenting with hirsutism and/or disturbed menstrual cycles, your doctor will likely order a hormone panel and look carefully at your androgens, FSH, and LH levels, plus take a history to see if you might have PCOS or (very unlikely) an ovarian or adrenal tumor. The frontline medication for excess androgens (assuming no cancer) is spironolactone. This is so effective that male-to-female transexuals use it to knock out testosterone almost completely. It is NOT SAFE in pregnancy.

Your doctor might also see other symptoms or might want to check the boxes and look at other vitamin and mineral levels, including B12, folate, vitamin A, vitamin C, selenium, and zinc. These are more long-shot.

Your doctor is likely to ask about any prescription medications you're taking, in case those are the culprit, and might change your prescription.

Your hair loss is most likely to resolve if you had severe thyroid issues or androgen excess that are successfully treated or if it was medication-induced. Because hair loss is a normal part of aging, if it is one of these other issues, you are likely to see only minor improvements.

What hair loss-specific treatments can the doctor prescribe?

For women, there are no prescription hair loss treatments. Minoxidil, which is over-the-counter, is the only FDA-approved medicine for women. That does not, however, mean it's the only thing that works! Minodixil does not depend on androgen knockdown for its effect, so it works in cases even where DHT isn't the culprit. Hair loss can improve in post-menopausal women with the use of estrogen in hormone therapy, but there are important risks to consider before taking this step. Your doctor should discuss these with you.

For men, there are finasteride and the more-powerful dutasteride prescription medications for androgenic hair loss. Finasteride is anti-androgenic and has a 2-4% risk of erectile dysfunction, ejaculatory dysfunction, and loss of libido, which is long lasting or even permanent in rare cases. It also decreases sperm count down to between half and 1/12th, with an average of 1/4th the normal sperm count being recorded. This would push a number of men into the infertility range, so if you're hoping to conceive and don't do so within six months, there's a high likelihood that the finasteride is to blame. The other FDA-approved medicine option is minoxidil, which doesn't work as well on men as it does on women but is very effective in greatly slowing hair loss in many men. Other things that aren't FDA approved also work.

Note that some doctors prescribe finasteride off-label for post-menopausal women, believing that the negative study was "fixed" to avoid lawsuits that might come about if a woman wasn't post-menopausal and got pregnant and her child had birth defects of the genitalia (highly likely for a male baby). Whether this works at all is debatable.

[Reyesuela]

Thinning Hair: How It Works (We Think!)

Say you aren't losing hair because of some underlying medical problem. What, then, is the cause, and how common is it?

Objective measurements find a lot more hair loss than women admit to. In one study of more than 400 randomly selected 63-year-old women, a third had Ludwig stage II or III hair loss--this is very severe hair loss, as women with stage I have already lost well over 75% of their crown hair! What stage 1 and 2 look like: https://www.youtube.com/watch?v=pMXqac025Zo For comparison, on the Savin scale, I was a Savin I-2 (I-1 is no hair loss) with at least 1/3 total hair loss at ponytail level--and a Savin II is a Ludwig I!

There are a number of factors that cause progressive hair loss in both men and women. The classical explanation is that circulating testosterone is turned into dihydrotestosterone (DHT) in the scalp through the androgen 5-alpha reductase, which occurs in sweat glands, oil glands, and hair follicles, Type 1 5α-reductase is expressed predominantly within the sebaceous gland, and type 2 5α-reductase, most commonly attributed to much if not all of the DHT manufacturing, is mostly located in hair follicles The DHT causes the hair to thin because it downregulates β-catenin/Wnt signaling, which in turn is what "turns on" hair follicles, sending them into the growing anagen phase and telling them to stay there. This also enlarges the sebaceous glands. In addition, VERY high levels of oxidative stress is usually demonstrated in the scalp of someone with high local DHT levels. In older women, lower estrogen seems to be implicated as aromatase binds androgens locally in the female scalp in the pre-menopausal woman.

All of this means that your hair grows for a shorter period of time, falls out sooner, becomes thinner and shorter each time (a process called miniaturization), until the hair follicle switches from terminal-type hair production (head hair) to vellus-type hair production (microscopic body hairs, like on your inner forearms) and then is eventually killed off.

The earlier in the miniaturization process we can get, the thicker your hair can be.

You might notice that we already know that there are a lot of moving pieces to this hair loss issue. Even completely blocking all DHT at the follicle level does not thicken hair or slow hair loss in everyone because β-catenin/Wnt signaling might be inhibited for other reasons completely unrelated to androgens or any other health issue--but non-androgen-based treatments can still work on these individuals. Which leads us to.....

Naturally Thin Hair that is NOT Thinning

If you have thin hair for your race, then most likely, you have the same number of follicles as everyone else, but your personal hormonal balance/sensitivity and your body's genetic hair growth clock tells it to have shorter default hair cycles, longer or more frequent telogen (resting) phases, and to make thinner hairs.

You would be nuts to try finasteride (as a man--women aren't prescribed this) in such a case. But the rest of the treatments do things other than knock down androgens on a body-wide level, and many have been shown to thicken individual hairs, increase hair density, and lengthen the anagen phase in a way that does or should work for people with non-thinning hair, too. Consistent use of minoxidil is also shown to prevent future hair loss, since it prevents hair loss better than it restores hair. I will note any side effects with these various approaches as they come up!

What I strongly discourage is sticking untested traditional remedies on your head or untested essential oils. While some work (most likely to do with their antioxidant properties), some have been shown to actually permanently destroy hair follicles. We don't want that!!!!

[Reyesuela]

Smoking might not be as "hip" as it was in the 50s, and 60s and 70s, but my mom and dad have both smoked their entire lives (they are both in their 70s now), and my dad has gone gray very gradually (still isn't fully gray), and my mom was gray by age 40-45. Is there any proof (study) out there that confirms this?

YES! Everything I have here is based on actual studies, but it's too much work to link them all.

Smokers had earlier onset of hair graying (smokers: 31 (7.4) vs. nonsmokers: 34 (8.6), P = 0.034). Using multiple logistic regression with conditional likelihood, smokers were two and half times (95% CI: 1.5-4.6) more prone to develop PHG. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673399/

(Edit: This best understood as smoking gives nearly everyone MORE gray hair EARLIER, which means that you have a much greater risk of premature graying, in the medical definition, and a nearly 100% chance of having significantly more gray hair earlier than you otherwise would.)


The mechanisms by which smoking causes hair loss are multifactorial and are probably related to effects of cigarette smoke on the microvasculature of the dermal hair papilla, smoke genotoxicants causing damage to DNA of the hair follicle, smoke-induced imbalance in the follicular protease/antiprotease systems controlling tissue remodeling during the hair growth cycle, pro-oxidant effects of smoking leading to the release of pro-inflammatory cytokines resulting in follicular micro-inflammation and fibrosis and finally increased hydroxylation of oestradiol as well as inhibition of the enzyme aromatase creating a relative hypo-oestrogenic state. https://www.ncbi.nlm.nih.gov/pubmed/12673073

(It will kill your hair. How much and how fast depends on a lot of things.)

There are approximately a bazillion studies on this. I just linked the first two. I don't state that "X totally causes Y" with just one study--I prefer 5 or more good ones.

[Reyesuela]

Active Treatment: Minoxidil
Quality of treatment: Front line
Level of evidence: Excellent. This is a gold-standard treatment.
Level of effectiveness: Mild to moderate improvement over baseline in 60% of men, more in women.
FDA approved: Yes.
Method of action: beta-catenin/Wnt signaling
Common side effects: Scalp irritation
Application: 2% twice a day, or 5% liquid/foam once or twice a day, following doctor's recommendations

Minoxidil is incredibly effective at slowing hair loss, moderately effective at stopping hair loss and increasing the diameter of hair, and mildly to moderately effective at regrowing hair from follicles that were not making hair but weren't dead yet. Because of women's pattern of hair loss, it is more effective on women than men.

Men have used minoxidil to thicken their beards with great success. You don't need to be balding for it to make your hair thicker!

Minoxidil was originally a vasodilator and blood pressure medication, but it wasn't a very good one because it had to be taken orally every four hours! But it did thicken people's hair. So it was repackaged as a topical solution that doesn't absorb well beyond the skin and FDA approved for hair growth. The vasodilator effect means that if it DOES absorb too well in the body, you can get a flushed feeling and your heart rate can increase as your blood pressure drops, and you can retain a lot of water, causing abrupt weight gain or swelling. This isn't a sign that it's working better! You should stop using it if you have these symptoms. Your doctor may recommend that you decrease your dosage or stop using it completely.

According to the FDA, women are recommended to use either 2% liquid twice a day or a 5% foam once a day. Men can use a 5% foam or liquid twice a day. The vehicle that delivers the medication is usually alcohol and propylene glycol. Minoxidil causes no irritation, but the vehicles frequently do. The foam is less irritating than the liquid, but I found it impossible to get on my scalp once my hair started really growing back, and some studies have shown it to be slightly less effective.

Women are more likely to get (or, more likely, NOTICE) extra hair on the forehead, cheeks, or "sacral region" (butt crack).
I have been using 5% minoxidil twice a day for months, and my eyebrows are bushier, with more eyebrow hairs, I've found two stray longer but fine white hairs ever on my cheeks. I do regular at-home laser treatment of my backside already, so I haven't noticed any difference there, but if I did, I would not care--depilatories work. I really don't care about any of these. I actually love the my eyebrows are going back to my youthful thickness. Thinning eyebrows are so aging!

Because 2% minoxidil works as well or better than 5% in men, women are recommended to start with less. For minimal irritation, I recommend starting with 5% foam once a day. If you get none of the more serious side effects (which are extremely rare), can choose, with consultation with your doctor, to ramp up to 5% liquid twice a day. If you start having serious irritation, let your scalp rest for a day. All your hair won't fall out from missing a few doses, and you're much more likely to develop tolerance if you're easy on your skin. If you can't tolerate either alcohol or propylene gycol, there are formulations without one or the other. There are some formulations without both, but they don't work as well.

How It Works--And What Stops It From Working

There was a lot of speculation that minoxidil vaguely "increases blood circulation," because of its effects as a vasodilator, but we now know it doesn't grow hair that way, mainly because we've discovered two things that keep it from working!

Minoxidil doesn't work at all ex vivo--that is, outside the body. Researchers discovered that the reason is that minodixil needs insulin-reactive scalp tissue and insulin to work. If you are a poorly controlled type-1 diabetic or you have type 2 diabetes/insulin resistance that is not rectified with medication, minodixil won't work for you well at all.

Minoxidil needs COX-1 enzymes to work. Taking daily doses of aspirin, ibuprofen, or naproxen will stop it from working. That's right: no aspirin therapy with minoxidil. You have to pick one. I start bleeding into the skin on baby aspirin (because my blood is already in such great shape!), sot this is a no-brainer for me. It might not be for you! I do now have to make harder choices about pain control, since Tylenol doesn't work nearly so well.

These have never been controlled for in minoxidil studies, so likely a pretty good hunk of weak responders were either on aspirin or insulin resistant, since both of these are very common in older adults likely to have balding.

NSAIDs (aspirin, etc.) by themselves haven't been shown to cause hair thinning when used chronically. But I don't think this has been studied. Insulin resistance does cause thinning on its own.

What It Does

Minoxidil tells your hair follicles to go into the anagen (growing) stage. Many people with thinning hair have an unusual proportion of follicles in the telogen (resting) phase. If they are already in the telogen phase but the hair has not yet fallen from the follicle, the hair must fall out before new hair can grow. Minoxidil also apparently can't keep hair that is fast approaching the telogen stage but not quite there from entering it. It actually tells these hairs to go into telogen faster so they can start with a fresh anagen stage. This increases the number of growing hairs.

Minoxidil also tells your hair follicles to thicken the individual hair shafts. This increases the number of terminal (vs. vellus) hairs, decreases hair miniaturization ("baby hairs" or ultrafine hairs), and thickens up even "regular" terminal hairs. This makes hair thicker around.

Minoxidil also increases the total number of hairs per follicle, mainly in non-Asians. This also increases the number of growing hairs.

Finally, minoxidil keeps hair in the anagen state for longer. This increases the total maximum length of your hair.

What to Expect

For anagen hair to grow, telogen hair must fall out. Therefore, for one to three months, people starting minoxidil experience increased telogen effluvium--AKA, more of your hair falls out! This doesn't mean that minoxidil is accelerating your hair loss. It can't do that. The only reason the hairs are falling out is because new hairs are coming in behind them. These hairs should be thicker and last longer than the old ones were going to do.

By month 6, you should know whether your hair will respond well to minoxidil based on the density at the scalp. If it is the same or slightly better than it was six months ago, you're a mild responder. If it's remarkably better, you're a strong responder. If it's slightly worse, you're a very weak responder. Very few people are complete non-responders. It should at least slow hair loss in almost everyone. It cannot accelerate hair loss, despite its hair syncing ability.

Among men who are suffering from hair loss, minoxidil, on average, gives 20 (at six months) and 50 (at one year) more terminal hairs per square centimeter. (The average healthy scalp has ~200 total.) Women respond better. The total hair thickness (ponytail thickness, basically) isn't studied.

Your peak hair density at the scalp will be reached between 1 and 5 years of treatment. After than, your hair desyncs and progressive aging-relating hair loss begins to take hold, but at a much reduced rate. In perspective: people general have better hair 15 years after starting minoxidil than at baseline. That means it turns back/slows the clock at least 15 years in most people.

[Reyesuela]

Active Treatment: Ketoconazole/Nizoral shampoo, AKA QUIT PUTTING MONISTAT ON YOUR HEAD
Quality of treatment: Adjunct
Level of evidence: Excellent.
Level of effectiveness: Roughly the same as minoxidil
FDA approved: No.
Method of action: No one knows!
Common side effects: Scalp irritation with overuse
Application: 1% 1-7 times weekly, 2% 1-3 times weekly, following doctor's advice

Ketoconazole comes in a 1% shampoo over the counter in the US and some countries and 2% either over the counter or by prescription (US) depending on the country. It is an antifungal shampoo for dandruff. It is supposed to be used for dandruff twice a week, due to the risk of scalp irritation. Some people can tolerate the 1% shampoo up to daily and the 2% up to three times a week. It needs to be applied to the scalp only for it to work.

I personally do conditioner (full head), shampoo (just scalp), conditioner (full head) with this shampoo.

People using ketoconazole noticed thicker hair, and so a number of studies were done on its effect on hair growth. The results were generally about the same as minoxidil, but it uses a different pathway, so it can be combined with minoxidil and other therapies for better effect. What pathway is that? you must want to know. No one knows! Some people thought that maybe fungal infections were causing hair loss in some people. That was disproven. Some people thought that it has an anti-androgenic effect on the scalp. It might do that, but mouse studies revealed that it wakes up hair in the telogen phase just fine when no androgens are involved in the condition at all! So what it comes down it is...we don't know. It works on people with thinning hair and people without thinning hair, to various degrees.

Unlike minoxidil, it doesn't seem to create much telogen effluvium at first. Like minoxidil, it takes about six months for most people to see clear results. At six months, most studies show about 20 extra hairs per square centimeter on average (in Caucasian men). It works for men and women.

What to Expect

Greater hair thickness or at least significantly slowed hair loss after six months. Fine tune your frequency to prevent scalp irritation, especially if you're adding it to minoxidil, which you should be if you've got hair loss.