In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See "Life cycle of a hair.") That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called "follicular miniaturization." As a result, thicker, pigmented, longer-lived "terminal" hairs are replaced by shorter, thinner, non-pigmented hairs called "vellus."
You may have seen the ads in the back of men's magazines, you've heard the commercials on the radio, and you've seen the infomercials promoting miracle treatments for hair loss. The bottom line is that most advertised "treatments" do not work for the prevention and treatment of hair loss. If a hair loss treatment is not approved by the FDA or recommended by the American Hair Loss Association, chances are you are wasting your time and money.
2. Volumizing shampoos and treatments. Typically, these work by depositing ingredients, like wheat protein and keratin, that adhere to the hair shaft to a) thicken it and b) create spaces between hairs so you look like you have more of it. Try Kiehl’s Rice & Wheat Volumizing Shampoo ($18) with hydrolyzed wheat protein; Rogers likes Redken Cerafill Defy Shampoo and Conditioner ($20 each) with ceramides that bulk up hair.
The only nonchemical option offered up by the dermatologists I spoke with — short of a surgical hair transplant or platelet-rich plasma therapy, which is like Kim Kardashian’s vampire facial but for your scalp — was the laser comb. First cleared by the FDA in 2009, the HairMax LaserComb is a handheld laser device that is designed to promote hair growth. As the manufacturer explains in a letter to the FDA, “The device provides distributed laser light to the scalp while the comb teeth simultaneously part the user’s hair to ensure the laser light reaches the user’s scalp,” which, in turn, stimulates the hair follicles.
Some treatments in development hold particular promise for women. Angela Christiano, a hair geneticist and Columbia University professor of dermatology, is hoping to begin clinical trials in a year or two on a procedure in which she dissects hair-follicle stem cells, grows them in the lab until she has several million, then injects them into the scalp, where, a very small study done with a human skin model has shown, they induce new hairs.

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Thanks for the help Domen. I currently use keto about once a week but I will ramp up to 3 times a week. I hear that helps for Sebum reduction. Do you agree? In terms of shedding, I shed very consistently . . . .about 15-20 hairs I notice in the shower when I shampoo, 15 hairs when i come out of the shower and comb my hair, another 5 every morning on my pillow and random hairs throughout the day that I notice on my desk.
The test involves plucking about 50 hairs from the head, typically at the back of the scalp, so your dermatologist can look at them under a microscope and determine how much of the hair is in the resting, growth, and fall-out phases. Next, a vial of blood is sent to a lab to check hormone and nutrient levels ($100 and up, depending on insurance). If low levels of iron, or high levels of male hormones, like androgens, are contributing to your hair loss, for example, both can be treated through oral supplements or medication.
During a hair transplant procedure, a dermatologist or cosmetic surgeon removes tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. Some doctors recommend using minoxidil after the transplant, to help minimize hair loss. And you may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.
During the trials on men with prostate problems, researchers noted an intriguing side effect: hair growth. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness. Minoxidil, a topical liquid solution, was already on the market (see below).
What is your opinion on laser combs? I went to the Men’s Club yesterday and they recommended I spend ~$800 to buy a laser band, comb or hat. What is your opinion on how those work? Sounds like snake oil to me. They also recommended I go to my dermatologist to get a prescription to reduce sebum in my hair. I have been on Fin for 11 months, Minox foam 1x/day yet hair shed hasn’t stopped. I do have a prescription for Ketoconazole shampoo but rarely use it. I read in your article that this shampoo does help with Sebum build up so I will try that. Any other recommendations for sebum reduction?
Retin-A, or topical tretinoin, is sometimes used as a combination therapy with minoxidil for androgenic alopecia. It’s important to use this type of medication under the guidance of your doctor. In some circumstances, tretinoin can actually cause hair loss. Some people who have used it at home report that topical retinol creams, serums, and lotions may make hair loss worse.
To us, that meant any product with zero proven ingredients, case studies, or FDA clearance — which shrunk our list by a whopping 180 contenders. That’s right, there are only three treatments that have actually been cleared by the FDA and supported with clinical studies: finasteride (commonly marketed as Propecia), minoxidil, and laser treatments. And, since finasteride is prescription-only, it left us with two.
"I recently started using your hair growth products, and now there is no looking back. My hair has always been really thin and fine and growth around the hairline at the temples has been poor. It almost looked like my hairline was receding. I didn't like putting my hair up as I looked like I was going bald. But, not any more. My hair feels thicker, and growth is improving at the temple area. My hair would never grow beyond my shoulders, that's going to be the next test, how long will it grow!! Thank you, after years of irritation with my fine hair things are looking up."
Just letting go is possibly the most challenging of the available options. It’s also the cheapest and ultimately the most effective in the struggle with hair loss. Given the imperfections of surgical, medical, and technological options, there are many who advocate simple acceptance. (BaldRUs.com is one of several sites devoted to embracing the scalp's natural fate.) What's more, the health benefits of happier mirror time -- and fewer years of harmful anxiety -- just might offset the loss of those Samson-like powers.
While you won’t find a miracle shampoo on the market, nioxin and some other products can help keep your scalp in tip-top shape to improve the look of any hairs you do have left on your head. In fact, feeding your hair with the proper nutrients both inside and out can make it appear healthier, so you might consider using products with natural herbs, such as rosemary and mint.
One hard truth: Hair loss is mostly out of your control. “Baldness comes down to your genes,” says Frederick Joyce, M.D., founder of Rejuvenate! Med Spa and a member of the International Society for Hair Restoration Surgery. “If you have the baldness gene, there are some natural remedies that may make your hair stronger and healthier to slow your hair loss slightly—but they won’t prevent you from going bald. Still, maintaining hair health by eating well and using the right products—combined with medical-grade treatments—can really work all together to help you have a fuller, thicker head of hair.”
Great article thx!! I’m 38 and still have a full head of hair but I started to shed about 3 months ago. Typically ~15 hairs on my pillow when I wake up and 20 or so hairs on my hand after I shower. I also notice hairs on my desk during the day. I never noticed any hair loss before 3 months ago. I started to use rogaine 5% twice a day about a month and a half ago and the shedding accelerated. I read that is normal but should it still be doing this after 1.5 months? I haven’t tried propecia yet as I want to see if Rogaine will do the trick but will if the shedding doesn’t stop. Also, do you think stress can play a part in hair loss? I started a super stressful job about 6 months ago so thinking my hair loss could be related to that.
There are several different types of medication you can buy to help treat hair loss. Procepia and Finasteride are currently the only approved drugs you can take that will effectively treat hair loss. The active ingredient in both treatments (finasteride) works by blocking DHT (the male hormone dihydrotestosterone) that causes hair loss by shrinking hair follicles on your scalp. It has been proven to lead to hair regrowth or to stop hair loss in around 9 out of 10 men in clinical trials.  
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