Cyproterone acetate is not available in the U.S. Doctors consider it one of the last resorts for treating female pattern hair loss because of its possible toxicity and long-term side effects. As with any drug, side effects other than those listed on the package may occur. Contact your doctor if you notice a side effect that is unusual or particularly bothersome.


In February, though, Ms. Telford, 46, flew from her home in London, Ontario, to Sarasota, Fla., for a new $1,400 hourlong treatment known as platelet rich plasma (P.R.P.), which is said to stimulate dormant hair follicles. The procedure involves drawing blood, spinning it in a centrifuge to extract the plasma, adding various nutrients (like more protein), then injecting the resulting mixture in one-inch intervals in a grid on the top of the scalp, which has been numbed with a local anesthetic.

“We’ve all heard the old wives’ tale that a guy’s hair is based on their mother’s father. That’s sort of true, but it’s not,” said primary care physician Dr. John Hong. “It’s really the total number of guys in your family that have male pattern baldness that will affect your risk, particularly your dad. If your dad is bald, you’re more likely to be bald.”

As the name suggests, androgenetic alopecia involves the action of the hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sex drive and regulation of hair growth. The condition may be inherited and involve several different genes. It can also result from an underlying endocrine condition, such as overproduction of androgen or an androgen-secreting tumor on the ovary, pituitary, or adrenal gland. In either case, the alopecia is likely related to increased androgen activity. But unlike androgenetic alopecia in men, in women the precise role of androgens is harder to determine. On the chance that an androgen-secreting tumor is involved, it's important to measure androgen levels in women with clear female pattern hair loss.
Adam Friedman, a program director at The George Washington University School of Medicine & Health Sciences, is on the same page as Romanowski. "While it does have antimicrobial properties which may be useful in terms of fighting off bacterial or fungal overgrowth on the scalp that can lead to hair-damaging inflammation, there is zero evidence [showing] it is helpful for hair growth," he says, adding that some people can actually be allergic to castor oil and experience inflammation, ultimately doing more damage than good to the scalp. "To propose that castor oil accelerates hair growth, a tightly regulated process (one centimeter per month) for which FDA approved medications for hair loss do not impact, is ridiculous," he states.
At the same time you supplement your diet with nutrients for hair growth and treat your scalp to stop hair loss, it’s a good idea to switch to a better shampoo and conditioner. For example, shampoos without sulfates are rapidly gaining in popularity. People now realize that sulfates strip essential oils from their scalp and leave their hair fragile and dry.
Instead, you may want to add vitamin D (about $15) to your shopping cart. A vitamin D deficiency can exacerbate hair thinning and make it almost impossible for any over-the-counter product to reverse hair loss, says Dhaval Bhanusali, a dermatologist in New York City, who recommends taking 5,000 international units of D3 a day (and it’s generally beneficial for bone health in women over 40). “There’s also a link between low iron and zinc levels and temporary hair shedding, called [telogen] effluvium,” says Rogers.
"Castor oil will not grow hair," says cosmetic chemist and author Perry Romanowski matter-of-factly. "There is no evidence for it and no scientific theory supporting that it would work, so yes, it's a total myth." In better news, he says that castor oil is not damaging to the hair and can provide some conditioning that improves the flexibility of the hair fiber.
"I recommend that everyone [with any hair loss] take finasteride," says Robert M. Bernstein, MD. Bernstein is associate clinical professor of dermatology at Columbia University and founder of the Bernstein Medical Center for Hair Restoration. "To patients who are younger,” he says, “I also recommend minoxidil. But the mainstay is finasteride. The data show that, over five years, it significantly retards hair loss in 85% of users."
Testosterone replacement is becoming popular for men. Cotsarelis warns that this may accelerate hair loss. Propecia might help -- but because it prevents testosterone breakdown, it might affect the dose of male hormone replacement therapy. Cotsarelis warns men taking both Propecia and testosterone replacement to make sure their doctor carefully monitors their testosterone levels.

Hair: It’s a natural part of being a human. But when the temperature climbs, and skin is exposed, it’s one of those things that a good many of us want to control. This week, we’re tackling hairlessness, not just the process of hair removal (electric shavers and ingrown-hair treatments and aesthetician-approved tweezers) but also what to buy when you’re losing your hair, and even how to take care of a Sphynx cat. Here, we’re talking to dermatologists and hair-loss doctors about hair-loss treatments that actually work.


No. Minoxidil topical solution 2% will not work faster or better if used more than two times a day. Studies have been carefully conducted to determine the correct amount of minoxidil topical solution 2% needed to get the best results. More frequent use or larger doses have not been shown to speed up hair growth and may increase your chances of side effects.

Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
Eventually, these follicles close completely and stop producing any new hair at all. In other instances, men will start to notice hair loss because of lifestyle and environmental factors. For example, being overly stressed for extended periods of time can cause for a man’s hair to start falling out in clumps. And if a man isn’t getting proper vitamins and nutrients to nourish his hair, the strands could possibly grow increasingly weaker until they start breaking off and thinning out. Luckily, there are many hair growth products for men on the market today which can help men in these situations to grow their hair back.

“If you don’t want a scar because you like to wear your hair short, you might opt for a “scarless” hair transplant,” says Dr. Joyce. Also known as follicular unit extraction (FUE), grafts are harvested one at a time with tiny punches that heal virtually undetected so you can still buzz your head. “If you’ve gone so bald that you don’t have a lot of donor hair on your head, we can do FUE extractions with body hair such as on your chest, stomach, back, and sometimes even the pubic area,” says Dr. Joyce.


Viviscal is a natural hair-growth supplement that promotes hair growth in people with thinning hair. It contains a marine complex known as AminoMar C. This is made of minerals, vitamins, and shark and mollusk powder. These ingredients help to regenerate new cells and strengthen existing cells. You have to take the pills twice a day for at least six months in order to see results. Viviscal also makes a shampoo and conditioner. 

The truth is, the amount of propylene glycol in hair loss treatments is not likely to cause any real harm and the FDA has given the chemical approval for many uses. But even though it is safe, we wanted to ensure that our top picks would be as comfortable to use as possible. So when Dr. Khadavi told us that “a third of my patients get irritated from minoxidil products because of propylene glycol,” we decided to cut any treatments with it. In any case, it’s the minoxidil that helps curb hair loss and not the propylene glycol.
Again, you’ll want to visit your doctor to get a blood test to check your levels in these vitamins. For example, women who have iron levels lower than 70 nanograms per milliliter are considered deficient. From there, work with your doctor to find an appropriate dose according to your deficiency level. Excessive or unnecessary supplementation can be dangerous.
Her hope is that the procedure (she has helped start a company named Rapunzel to develop it) will eventually become another lunchtime cosmetic treatment. Once a patient has had her cells harvested and cultured, they could be stored indefinitely; then, after giving her doctor a month’s notice (the time it takes to grow the million needed), she could pop in for injections. Costs would likely be on par with hair transplants, roughly $10,000 and up.
However, ketoconazole is still not FDA approved for hair loss treatment, which means it cannot be endorsed or marketed as such. Put simply, ketoconazole likely curbs hair loss, but additional research is needed for the FDA to give it approval. While it is safe to use as a supplement to our top picks, we wanted to recommend products with as much scientific backing as possible. So, we stuck with FDA approved minoxidil or FDA cleared laser treatments. But we’ll keep a close eye on products like ketoconazole shampoos and update as new research appears.
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.
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." 
×