Trichorrhexis nodosa occurs when hairs break secondary to trauma or because of fragile hair (Figure 7). It affects the proximal hair shaft, although the distal shaft may also be involved.20 Causative traumas include excessive brushing, heat application, tight hairstyles, trichotillomania, and conditions that cause excessive scalp scratching. Chemical traumas include harsh hair treatments (e.g., excessive use of bleach, dye, shampoo, perms, or relaxers21) and excessive exposure to salt water. Examples of congenital or genetic conditions that may cause trichorrhexis nodosa include trichorrhexis invaginata (bamboo hair), intussusception of the hair shaft at the keratinization zone, Menkes disease, keratinization defects due to defective copper metabolism, and argininosuccinic aciduria.22 Rarely, trichorrhexis nodosa can be a manifestation of hypothyroidism.23
Key features: Dr. Zeichner recommends the Keratin Oil Shampoo and Conditioner by OGX for thinning or fine hair that needs the extra strength. This budget-friendly option uses keratin proteins mixed with argan oil to nourish, condition, and strengthen strands, and it's only $16 for the set. The smoothing formula can also increase elasticity for less breakage and split ends.
But here's one thing that most people miss when they talk about hair loss: It's part of the natural process of the hair growth cycle. Shedding hair is normal, and losing hair as we age is normal. However, there are instances when we are shedding hair at an abnormally faster rate than usual - and this is something that we have to pay attention to. It's also perfectly understandable and acceptable that some people would like to reverse the hair loss that comes as part of the aging process.
The history and physical examination are often sufficient to determine a specific etiology for hair loss. It is convenient to divide the various causes into focal (patchy) and diffuse etiologies, and proceed accordingly. Patchy hair loss is often due to alopecia areata, tinea capitis, and trichotillomania. Diffuse hair loss is commonly due to telogen or anagen effluvium. Androgenetic alopecia may be diffuse or in a specific pattern, and may progress to complete baldness.

Yet another company has made news this week for phase 2 trial progress. Concert Pharmaceuticals announced today that they have completed enrollment for their phase 2a trial using CTP-543 in alopecia areata. CTP-543 is an oral JAK inhibitor which acts on JAK 1 and 2, it’s also known as ruxolitinib. Concert’s version of ruxolitinib has been modified by the company’s proprietary deuterium chemistry technology which the company hopes will improve its effects on AA.
While not a cure for hair loss, this will clear up the muddy waters no doubt. DNA-testing is just starting to be commercially available and by 2020 you’ll be able to count on the likelihood that it will be much more advanced and affordable. Knowing for a fact at an early age whether or not someone will be predisposed to losing their hair will make a huge difference.  This will help that individual be able to plan, budget, and research their options before their hair even begins thinning.
RiverTown Therapeutics is in the Follicum camp: RT1640, the compound that David Weinstein developed, is applied topically. Compared to the aforementioned companies, though, RiverTown is way behind. Weinstein and his business partner, Michael Altman, are currently looking for investors to fund clinical trials. But only they have the flashy declaration that the founder has managed to grow back his own hair. Through coverage on sites like Follicle Thought, RiverTown is now a cult favorite in the hair-loss community.
What fans say: With a 4.5-star rating on Amazon and over 500 customer reviews, people love this herbal shampoo and conditioner set. One user said, "I bought this set because my scalp became dry and itchy in the winter months. I get my hair colored so I wanted something natural that wouldn't strip the color from my hair. Within just a few uses, I had immediate relief and no dandruff. I highly recommend this product."
I’ve just come across the official press release from Organ Technologies (the biotech company which is developing Tsuji’s methods) regarding their recent advancements in hair follicle cloning. It contains the important information which has already been listed on Follicle Thought, though it  also includes many more details. The press release is titled Organ Technologies and RIKEN Launch Preclinical Tests in Hair Follicle Regenerative Medicine. 
This moisturizing double-duty product is incredibly well rated (and you don’t even have to pay the pink tax to boot). Soy proteins and shea butter add silky strength, while scalp-tingling peppermint and rosemary provide minty freshness and lift at the root. “The thickening properties of the shampoo are great at this price point, so if you have thin or thinning hair, this will add some volume,” wrote one reviewer. “I also noticed that this is the first shampoo/conditioner shampoo that tends to actually condition your hair."
And though this treatment appears to be safe and somewhat effective, it’s hard to tell who will react well to this low-level light therapy, which is why the doctors I spoke with were hesitant to fully endorse it. “We’re not sure what the optimal power is, what the optimal wavelength is, we don’t even really know the mechanism of action of how this is working,” says Rieder. Plus, it doesn’t work on everyone. “There are subpopulations of patients who do respond to low-level laser light, but this is not easily predictable,” explains McMichael, though she adds that the risk of using the LaserComb is low.
Laser treatments. Low-level laser therapy (LLLT) is used for the prevention and reversal of hair loss. Also known as red light therapy, cold laser, and soft laser, it is a form of light/heat treatment (therefore generally safer) that is used on cases of pattern baldness and alopecia areata. The procedure uses a device that emits light that penetrates into the scalp. The more commonly used lasers are the excimer, helium-neon and fractional erbium-glass. The procedure can increase the blood flow in the scalp to stimulate the follicles that are in resting or dormant phase to go into anagen, and at the same time, prevent the production of DHT, which destroys the hair follicles.
The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.
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.
Finasteride (Propecia). The drug is recommended for male use only, and is in pill form. The drug basically slows down hair loss, while promoting gradual hair growth. The drug works by stopping the enzyme, type II 5-alpha reductas, which is known to produce DHT. The dosage is one pill a day, and has been found to be effective on 80% of men. Like minoxidil, it works best if the bald patches still have tiny, fine hairs. Results are visible within six to three months, and studies of those who have continued its use for two years show longer, thicker hair than those who used it for only for a short time.
And just like that, more fascinating hair-related research was published in PLOS Biology. A team of researchers lead by Dr. Nathan Hawkshaw of the University of Manchester have identified the drug ‘WAY-316606’ as a potential candidate for hair regrowth. WAY-316606 is an existing drug used to treat osteoporosis. It’s not clear at this time whether WAY-316606 is approved and on the market, or if it was partially developed to treat the bone disease.
“The DHT hormone (dihydrotestosterone) can contribute to thinning in women who are genetically predisposed to female pattern thinning,” Fusco says. For those whose case falls into this category, she advises a prescription shampoo with ketoconazole 2 percent, as it has anti-androgenic properties. “Ketoconazole has been proposed to disrupt the pathway of DHT leading to thinning of follicles.”

Caffeine – Quickly finding its way in to many skincare products for both men and women, caffeine is a natural antioxidant that not only fights free radicals that accelerate the signs of aging, but also help to stimulate the growth of hair. In fact, in a recent study published on the National Institute of Health (NIH) website, it was discovered that there were ‘growth-promoting effects’ to the hair with regular application (source).


Pay attention to the foods you eat and how much you’re eating. For example, eating a variety of whole foods that are rich in vitamins and minerals will help fuel your body and the areas responsible for hair regrowth. If you suspect you may be deficient in certain vitamins, visit your doctor to get a blood test and address other dietary issues, such as eating disorders or health conditions that might block nutrient absorption.

“There’s the ‘I don’t date bald men’ line – hard to argue with, but still an injury to one’s pride.” Then there are a surprising number of people who call out “baldie!” in the street, or equate a shaved head with homosexuality and/or neo-Nazism. “I’ve had baldist/homophobic abuse in the street a couple of times and I’ve even been asked on the Tube: ‘Are you BNP, mate?’ When I expressed bewilderment at this, I was told: ‘It’s the hair, innit.’”
Minoxidil (Rogaine, generic versions). This drug was initially introduced as a treatment for high blood pressure, but people who took it noticed that they were growing hair in places where they had lost it. Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then a 5% solution has also become available when a stronger solution is need for a woman's hair loss.
Unfortunately nutritional supplements are hit and miss. While the risks of side effects go down which is attractive, clinical data is sparse. In most cases the individual has to conduct their own experimentation. At 6 months a pop for a fair trial, this is a time consuming process. Time is a very limited commodity especially in the hair loss game. As we know, it is easier to do preventative maintenance than reverse hair loss. Nevertheless, natural DHT inhibitors like saw palmetto and nettle have worked to prevent hair loss in some users.
Anagen effluvium is usually reversible, with regrowth one to three months after cessation of the offending agent. Permanent alopecia is rare. A large meta-analysis of clinical trials concluded that scalp cooling was the only intervention that significantly reduced the risk of chemotherapy-induced anagen effluvium.27 However, scalp cooling should be discouraged because it may minimize delivery of chemotherapeutic drugs to the scalp, leading to cutaneous scalp metastases.27
Lipogaine Big 3 does contain ketoconazole, but only a couple other hair loss/thinning related ingredients. Their Big 5 does not contain ketoconazole, but it does contain a proprietary mix of 17 ingredients for hair loss/thinning. It seems to be a more complete shampoo overall, aside from the hair loss aspects. My initial thought is to go with a combination of Big 5 and Nizoral.
Many other women, though, start noticing thinning hair on top of their heads. Doctors say the defining sign is a widening of the part. The hairline itself is usually intact, but the hair becomes less dense behind it. Doctors will often run a battery of tests to make sure there are no treatable medical conditions, such as anemia, thyroid problems, tumors, or hormonal problems. "Ninety percent of the time, it's normal," Patel said.
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