Minoxidil and oral finasteride are the only treatments currently approved by the U.S. Food and Drug Administration for the treatment of androgenetic alopecia. Both of these drugs stimulate hair regrowth in some men, but are more effective in preventing progression of hair loss. Although there are a number of other treatments listed in various texts, there is not good evidence to support their use.8


During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of tiny grafts, each containing just a few hairs. Each graft is planted in a slit in the scalp created by a blade or needle in the area of missing hair. Hair grows naturally this way, in small clusters of one to four follicles, called follicular units. As a result, the graft looks better than the larger "plugs" associated with hair transplants of yesteryear.
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.
This super-clean (and paraben- and sulfates-free, non-GMO, and vegan) shampoo zones in on the hair-saving supplement you’ve been hearing about for years: biotin. Nature’s Gate pairs its key ingredient with bamboo, a silica-packed scalp cleanser, and follicle-fortifying pro-vitamin B5. “I have thin hair that was breaking off and clogging my drain,” one reviewer wrote on Amazon. “No longer ... I may not have thick hair but it is stronger after using this shampoo.”

You can also get a hair-loss kit from Hims, which comes with both minoxidil and finasteride. Keeps has one, as well. And though it might seem like overkill to take two different hair-loss treatments at once, this is one of those rare instances where more is actually better. McAndrews calls the combination of orally administered finasteride and topically applied minoxidil a “full-court press” against hair loss. “That’s doing the most you can for preventative medicine.” Rieder notes that taking both drugs together is more effective than taking either one alone.

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."
In fact, the Japanese government has recently committed to establish a new approval process for regenerative medicine products focused on accelerating approval timelines. As it turns out, hair loss is a big concern in Asian countries. Buckler said some 21% of adult males and 6% of females in China suffer from hormone-driven hair loss.  And the International Society of Hair Restoration Surgery’s (ISHRS) biennial survey of hair restoration physicians found that the number of hair restoration patients in Asia increased 345% from 2004 to 2010.
A little something for you all to nibble on. I’ve recently discovered a stem cell therapeutic company who has an interest in putting out cosmetic hair growth products. The company, Stemedica, is working on treating a wide range of diseases through clinical stem cell therapies. I counted 6 clinical trials in progress on their pipeline page. Perhaps more interesting for this audience, the company is also developing skin and hair growth cosmetic products from their core stem cell technology. Stemedica has a specific subsidiary in place to roll out dermatology cosmetics called StemCutis. Their website mentions the use of stem cell-derived growth factors to to be used in the products. It’s not clear what stage of development the hair growth product is at, but it’s good to have it listed in Stemedica’s sights. 
All that said, our primary consideration for choosing hair loss shampoos for our list was whether it produced actual results. We also acknowledge that what might work for someone may not work for another, but we’re interested in the overall picture. Perhaps not surprisingly, the “big names” in the hair loss game – Lipogaine, Nizoral, etc. – made the grade, in part, because they’ve accumulated years of successful results.
Hair changes about as fast as grass grows, which is to say it’s extraordinarily slow and not visible to anyone checking impatiently in the mirror every day. But during regular follow-up appointments, Harklinikken uses high-tech equipment to photograph and magnify the scalp and count new hairs and active follicles, which motivates users to adhere to the regimen. Too many people give up on treatments like Rogaine and low-level-light devices before they’ve had a chance to work, Dr. Senna said.
Tissue expansion. In this procedure, a material called a tissue expander is inserted under portions of the scalp with hair. Saline water is injected for six to eight weeks in order to expand or stretch this portion of hair-bearing skin. The bags are eventually removed and the expanded hair-bearing skin is cut away and moved to the adjacent bald area. This is typically used to address hair loss as a result of burns or injuries on the scalp.
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.
One is how much emphasis the company places on compliance, the major stumbling block in the efficacy of any treatment, said Dr. Senna, an author of studies on the subject. Prospective users are questioned about their ability to stick to a regimen because the extract must be applied every day, and they are told that the more conscientious they are, the better. Users are also reminded and encouraged with regular check-ins.
More good research coming from the University of Alabama at Birmingham shows that a certain gene affecting mitochondrial function can dramatically reverse signs of aging in mice. The aging factors which were shown to be reversible include skin wrinkles, gray hair, and hair loss. Next comes the important phase where the researchers continue forward to translate this discovery to human use. Full article on the front page.

You might think, "It's just hair", but think about this: What would you do if you wake up one day without a single strand of hair on your head? However, as we've mentioned, hair loss is a natural physiological process. In the hair growth cycle, old hair has to be shed in order for new hair to grow. As we age, our body's capacity to produce hair also slows down, similar to when our bones stop growing at a certain point in our lives.


Alexey Terskikh PhD of Sanford Burnham Prebys research institute has news to share about his hair follicle research. The Articles page gives you all the highlights on what advancements Terskikh has made over the past three years and when he is planning to take his cloning method to FDA human trials. This is one example of a peer reviewed journal article which actually developed to human translation in a timely manner. Happy Friday

“I was 21 when I noticed my hair getting thinner,” says David Anderson, 45, who has had seven hair transplants. He is now senior patient adviser at the Maitland Clinic in Liverpool, one of the country’s leading hair transplant clinics, where he raises awareness of the vulnerability of sufferers. “It was devastating. It completely consumed my existence. Now, I really regret that. But time and again, I’m meeting patients going through the same anxieties. It’s an epidemic. A lot of people don’t understand how it can make you feel.”
"Despite some of the claims, a shampoo or conditioner won’t be able to stop or slow hair loss, nor help with a receding hairline or thicken hair that’s becoming thinner," says trichologist Anabel Kingsley from The Philip Kingsley Trichology Clinic in London. "At best, a thickening shampoo will make hair temporarily thicker for a short period of time, but they certainly won’t help with hair loss or thinning." 

Hair changes about as fast as grass grows, which is to say it’s extraordinarily slow and not visible to anyone checking impatiently in the mirror every day. But during regular follow-up appointments, Harklinikken uses high-tech equipment to photograph and magnify the scalp and count new hairs and active follicles, which motivates users to adhere to the regimen. Too many people give up on treatments like Rogaine and low-level-light devices before they’ve had a chance to work, Dr. Senna said.


3. Nutriceuticals. Rogers recommends that her patients try Viviscal Dietary Supplements ($50 for a one-month supply) or Nutrafol ($88 for a one-month supply), both of which can often be picked up in a salon. The former contains marine-based proteins meant to beef up thinning hair. The latter is packed with antioxidants, like ashwagandha and curcumin, and boasts impressive clinical results.
In the initial decade after the first identification of the hedgehog gene around 1980, there was almost no research devoted to the impact of the SHH pathway upon human hair. However, this started to change in the mid-1990s (e.g., this from 1998) and culminated in the seminal work on this subject that was published in the US in 1999: “Induction of the hair growth phase in postnatal mice by localized transient expression of Sonic hedgehog“.
Thanks so much for the guidance! After further research I have to agree with you 100%. Lipogaine Big 3 does containe ketoconazole, which would eliminate the need for Nizoral, however the shampoo only contains a few hair loss/thinning related ingredients. The Big 5 contains 17 and just seems like a better overall product. That plus Nizoral twice weekly seems pretty solid to me.
Women’s magazine ‘New Beauty’ recently featured several prospective hair growth therapies in a print article. The feature contains several interesting and worthwhile anecdotes. Check the Articles main page to read about Dr. Cotsarelis’ new research on setipiprant for female alopecia, Histogen’s view on the number of injection sessions which may be necessary to get the most out of HSC, and more.

This is a short-term cure, applied while waiting for hair to grow, and therefore recommended for those with a mild to medium case of hair loss. In addition to being non-invasive, hair concealers and hair fibers are instant and affordable. Like wigs and hairpieces, they are used to effectively cover up balding spots while not getting in the way of growing hair. Compared to wigs, however, they are more natural looking and blend well with your natural hair, therefore drawing less attention when you're out in public.
Hair is made up of the hair follicle (a pocket in the skin that anchors each hair) and the shaft (the visible fiber above the scalp). In the hair bulb, located at the base of the follicle, cells divide and grow to produce the hair shaft, which is made from a protein called keratin. Papilla that surround the bulb contain tiny blood vessels that nourish the hair follicles and deliver hormones to regulate the growth and structure of the hair.
Hair grooming, but more importantly, having a head-full of hair is as important to men as it is to women. To women, it may be an important accessory of beauty, and for men, it adds to a sense of manliness, enhances their looks and makes them more appealing and attractive to women. Balding to men is associated with aging (only old men are expected to lose hair) and therefore, having hair on one's head is a sign of virility and masculinity.
It wasn’t quite the “accident” it was portrayed to be. He worked out that the drug targeted a protein called SFRP1, which affects follicle growth. He looked into the literature and discovered there was a pre-existing osteoporosis drug, WAY-316606, designed to target this protein with much more precision. So he applied that to leftover slabs of scalp donated by hair transplant clinics. “We usually do experiments for over a week. We put the hair follicles in a dish and this drug enhanced hair shaft elongation within two days. But it also kept the hairs healthier. When you look at them, they’re larger, thicker hair follicles. So, it’s quite promising.”
In Vancouver, a Canadian company called RepliCel focusses on the hair follicle’s “dermal-sheath cup cells,” its C.E.O., Lee Buckler, explained. Buckler believes that DHT attacks these cup cells “like a parasite.” Like Histogen, RepliCel’s consumer product would be an injectable. The company would generate new versions of your cup cells, which would be implanted into your “affected area”—the places where your hair has fallen out. Boom: new hairs. (Theoretically.)
The combination of silent suffering, public shame and poorly understood science makes hair loss sufferers easy prey – type “hair loss” into Google and you’ll see what I mean. Kobren tells me that he had to remove the personal messaging function on the Bald Truth message board, as users were being bombarded by scams. Meanwhile, the higher visibility of celebrity transplants means that baldness is at risk of being seen as a sign of poor self-care. Many treat surgery lightly – and enter into punitive financing deals. One of Kobren’s recent guests was The Only Way is Essex star Maria Fowler, who complained that surgery at the controversial KSL Hair in Glasgow left her with an unnatural hairline. “She ended up having a hair transplant because her fiancé was having one. She had always thought her hairline was too high. She went in like she was having her nails painted – and it destroyed her life.”
Approved by the FDA and available in over-the-counter form for both men and women, minoxidil has been found to work in two out of three men. However, and this is a huge problem, if you stop using it, then your hair will actually fall out again and potentially faster than before. Plus, you might not even notice any changes until you’ve been using this medication for at least four months!
A company not previously discussed in online news, SWITCH BIOTECH, has sights on developing a drug for androgenic alopecia. As you will see, the company is still in the very early stages of developing a therapy for AGA, however they are a knowledgeable dermatology-focused company and have a unique method of drug development. Here’s a quote from their website about working on AGA:

Re the post 10/17/18 I really liked your response to the request made by one of your readers to email companies asking for information. So I decided to do what you suggested and sent emails to Organ Technologies, Rivertown and Follicum (no particular reason) basically thanking them for their work and wishing them success with their products. Interestingly I received a very nice response from Organ Technologies which really surprised me. Correct me if I’m wrong but I think the sentiment is to be thankful and encouraging to what is being done appose to being negative that we have yet to get what we all want.
The optimal treatment for this condition is not known, and psychiatric referral may be indicated. Treatment options include cognitive behavior therapy19 and selective serotonin reuptake inhibitors, although strong evidence of a treatment effect has not been demonstrated. Preliminary evidence suggests positive treatment effects with acetylcysteine, olanzapine (Zyprexa), and clomipramine (Anafranil).19 A combination of cognitive behavior therapy and medications may be more effective than either approach alone.19
The best hair loss shampoos are gentle enough so that you can use them multiple times a week. Nizoral, however, is most effective when used only a few times a week (and should be left on the hair for three to five minutes before rinsing). But you can also alternate Nizoral with another type of hair loss shampoo – such as the Lipogaine products or Alpecin’s Caffeine shampoo – for an effective one-two hair loss fighting punch. Use Nizoral twice a week while using your other hair loss shampoo on the other days.
Always shampoo and condition your hair regularly. Let your hair breath by avoiding wigs that are made with cotton and nylon caps that absorb moisture and lead to drier and more damaged hair. Instead, choose those with netted caps. Make sure your wig isn't too tight. Secure it with hypoallergenic double-sided tapes. Do not put your wig on over wet hair to avoid the growth of mildew and bacteria.
3. Nutriceuticals. Rogers recommends that her patients try Viviscal Dietary Supplements ($50 for a one-month supply) or Nutrafol ($88 for a one-month supply), both of which can often be picked up in a salon. The former contains marine-based proteins meant to beef up thinning hair. The latter is packed with antioxidants, like ashwagandha and curcumin, and boasts impressive clinical results.
decrease in your blood Prostate Specific Antigen (PSA) levels. Finasteride can affect a blood test called PSA (Prostate-Specific Antigen) for the screening of prostate cancer. If you have a PSA test done you should tell your healthcare provider that you are taking Finasteride because Finasteride decreases PSA levels. Changes in PSA levels will need to be evaluated by your healthcare provider. Any increase in follow-up PSA levels from their lowest point may signal the presence of prostate cancer and should be evaluated, even if the test results are still within the normal range for men not taking Finasteride. You should also tell your healthcare provider if you have not been taking Finasteride as prescribed because this may affect the PSA test results. For more information, talk to your healthcare provider.
The Rogaine rep we spoke to explained that the different packaging (and therefore different prices) has to do with the FDA-approval process: “We discovered in clinical trials that the hair loss patterns between men and women are different,” she said by way of explanation. “Men typically have that bald spot on the crown of their head, where women generally have a general thinning throughout, but concentrated more on the top of the head. So for FDA approval, we had to come up with two different, gender-specific products, so the directions were more explanatory.”
I have only used this twice, but in that short time of use, I believe my hair shedding has increased. In fact, immediately following the last use my hair seemed to be coming out more than I had seen prior to ordering the shampoo at all. Experiencing hair loss, thinning, or excessive shedding (especially for a woman) can be very distressing, and to purchase a product in hopes that it will help to curb or even reverse the issue only to find it exacerbates the problem is INCREDIBLY stressful. I was hopeful about this product, given the overall reviews, but I'm afraid to use this product even one more time, for fear of making my hair loss worse.

Key features: The Dove Dermacare anti-dandruff 2-in-1 shampoo and conditioner is a solid option for dandruff management that's also super affordable. For $15, you'll get not one, but two bottles. Its active ingredient is pyrithione zinc, an anti-fungal ingredient commonly used to treat psoriasis that Dr. Zeichner recommendeds for dandruff. The formula is effective in treating scalp dryness and flakes because of it, and it has a refreshing mint scent.
These days, when forced into windy outdoor situations, Trump is nearly always seen wearing a Make America Great Again cap. But, one wintry, blustery day this February, Trump walked up the steps of Air Force One capless. In the engrossing video footage, you can see the hair on the back of Trump’s head part and rise, shooting up with power, almost in two separate flaps—one to the left, one to the right.

Not surprisingly, treatments with 5 percent minoxidil work better than treatments with 2 percent minoxidil. A randomized clinical trial published in the American Journal of Clinical Dermatology in 2002 found that, in men with androgenetic alopecia, “5 percent topical minoxidil was clearly superior to 2 percent topical minoxidil and placebo in increasing hair growth.” The difference was actually pretty astounding — after 48 weeks, the men who used 5 percent minoxidil experienced 45 percent more hair growth than the men who used the 2 percent treatment.
RepliCel is a regenerative medicine company focused on developing autologous cell therapies (or therapies that involve one individual as both donor and recipient) that address conditions linked to a deficit of healthy cells required for normal healing and function. Located in Vancouver, British Columbia, the company has developed first-of-their-kind cell therapies that will, they hope, treat conditions that now affect 1 in 3 Americans: pattern baldness, aging and sun-damaged skin, and chronic tendon degeneration.
I am a 45 yr female that has experienced hair loss to the point of having to hire a plumber twice (over 3 years) to unclog our drain in our main bathroom although I am pretty cautious about picking up my hair. My ponytail is about 1/2 the size that it was 5 years ago. i had excessive hair loss after the birth of my last 2 of 3 children. It is noticeably thinner although my employees, friends and husband seem to think my hair is thick. I can see my scalp very easily. (No patchy alopecia though) I started using viviascal professional strength about 2 months ago and hair surge shampoo only about 2 weeks ago. The bottle has about 1/3 left and i am wondering what is to be expected from this product. I have to use at least 8 pumps ( it seems to be double the volume of normal shampoo that i use) and it does not seem to later that well until after a min or so. Additonally i am using the hair surge supplement. When should i see less hair falling out? When should i expect visible results. Any other suggestions? I know it says to use 5 of 7 days, but i use it daily to make sure i am getting the full benefit ( if any) from this product. Currently i am looking at 100 buck a month for the shampoo alone if i keep this up. Any advice is welcome. Thanks
Hair styling products from shampoo, conditioner, to hair dye, bleach, gels and perm and straightening products may contain chemicals that can damage the scalp and cause the shaft to break, resulting in hair thinning. Beware of these products that contain toxic chemicals such as arsenic, thallium, meadow saffron (colchicum autumnale), and lead. These chemical ingredients can manipulate and disrupt the natural hair growth cycle, for example, shortening the anagen phase of growth. Hair procedures like hair relaxing and permanent waving, while do not lead to permanent hair loss, can damage the quality of the hair and make it more prone to hair breakage.
The earlier you begin treating hair loss, the more effective the treatment will be. Androgenetic alopecia is a condition that gradually worsens over time, so the general rule is that the earlier you seek treatment, the better. “If you’re losing your hair and you have genetic hair loss, using medication such as Propecia or minoxidil is most effective when started early,” says Dr. Robert M. Bernstein, Dr. Wolfeld’s colleague at Bernstein Medical – Center for Hair Restoration. Because not everyone loses hair on the same timeline, you can’t rely on statistics to tell you when you should start treatment. Some men start to notice thinning in their early 20s, while others maintain a thick head of hair well into their 50s. If you suspect that you’re starting to lose your hair and want it to stop, act quickly.
If you do decide to start treatment to save your hair, a good place to start is with minoxidil, more commonly known as Rogaine. Don’t expect this hair-loss treatment to create luscious locks; minoxidil is better at slowing down or preventing more loss rather than promoting hair growth. But, according to Dr. Amy McMichael, professor and chair of Wake Forest Baptist Medical Center’s Department of Dermatology, it is effective “if used as recommended, with evidence of improvement seen around six to nine months.” Simply massage the foam or solution into your scalp once or twice daily, and for best results, use a formula with 5 percent concentration.
Joseph Greco, Ms. Telford’s practitioner, who shares a patent for a process to remove growth factors from platelets, said he gets results in 80 percent of patients, more than half of whom are female. Roughly half of them fly in and out, often on the same day, he said, because the procedure doesn’t require downtime and has minimal side effects. (Small clinical studies suggest further research is necessary but acknowledge the procedure’s “excellent safety profile.”)
I must have had about 5 readers email me today about the fascinating research coming out of Yokohama National University in Japan. Professor Junji Fukuda lead the efforts to successfully prepare “hair follicle germs” at large scale simultaneously. Essentially, the researchers prepared a cellular formulation with the right culturing materials to promote successful growth and development of tiny “hair follicle starter kits.” Source article here. 
The beauty of Nizoral is that it performs three tasks simultaneously; 1) it cleanses the scalp, 2) its anti-fungal properties combat dandruff, and 3) it blocks androgen receptors to deter hair loss. Some caution should be taken when using Nizoral, however, because some studies have shown that leaving it on your hair for an extended period (i.e., five minutes or more) can cause rashes and irritation. Be careful if you have sensitive skin.
Since PhytoCayne Revitalizing shampoo is so watery, it’s easy to overpour and waste a good amount of this expensive product. That’s one reason we rank it below Revivogen and Nioxin. The more important reason for the #3 ranking is that this shampoo doesn’t do everything that the other two products do. It’s still effective for most users, however, and worth a try.
Some of the more commonly known natural DHT blockers are saw palmetto and nettles root but there are many lesser known herbs that have been discovered to act in some way to reduce DHT. DHT blocking shampoos sometimes use as many of these herbs as economically possible, while others only include a few of the more popular ones. All of the shampoos that made are top 5 list below are known to be anti DHT shampoos.
The general medical consensus around laser treatments — caps and combs alike — is that low-level laser light therapy stimulates the cells within the hair follicle. These devices may also increase cell metabolism to promote thicker and more durable hair shafts, something that neither minoxidil or finasteride can do. To use the HairMax Ultima, all you have to do is glide the device over your scalp slowly. Treatments should take about eight minutes, and you should do it three days per week for the best results.
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.
Alopecia areata. This condition, called patchy hair loss, is the opposite of pattern baldness. Whereas in the former, thinning hair follows a pattern, alopecia areata is marked by smooth and bald patches anywhere on the scalp. The bald patches are circular, and can be as small as a pencil eraser or as big as a quarter. It begins with one or two spots that multiply on other parts of the head. The condition is caused by an autoimmune disease where the antibodies mistake the hair as the "enemy" and start attacking it, resulting into hair loss.
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