Patients with hair loss will often consult their family physician first. Hair loss is not life threatening, but it is distressing and significantly affects the patient's quality of life. The pattern of hair loss may be obvious, such as the bald patches that occur in alopecia areata, or more subtle, such as the diffuse hair loss that occurs in telogen effluvium. As with most conditions, the physician should begin the evaluation with a detailed history and physical examination. It is helpful to determine whether the hair loss is nonscarring (also called noncicatricial), which is reversible, or scarring (also called cicatricial), which is permanent. Scarring alopecia is rare and has various etiologies, including autoimmune diseases such as discoid lupus erythematosus. If the follicular orifices are absent, the alopecia is probably scarring; these patients should be referred to a dermatologist. This article will discuss approaches to nonscarring causes of alopecia.
Thank you so much for responding, Domen! Another question after further research this weekend. – have you heard of/used/reviewed a product called Regenepure,? The shampoo contains 1% ketoconazole and is the same price as Lipogaine, Used every day, that would seem to eliminate the need for adding Nizoral to the weekly regimen. Curious to hear what you know about that product. Thanks again!!!
Finasteride comes in the form of a tablet and works by inhibiting the formation of DHT, a hormone which permanently damages hair follicles. They are only appropriate for use as a male pattern baldness treatment and must be taken once a day for 3-6 months for the effects to be seen. In one study, 90% of men with mild to moderate hair loss saw positive effects after taking finasteride for six months, with hair loss stopping and in some cases even reversing. Finasteride is therefore very effective while it is being taken, but will not continue to have an effect after treatment has ceased. Around a year after you have finished taking Propecia or finasteride, you can expect your hair loss to have resumed and any hair regrowth to have fallen out. For this reason, they are not cures so much as effective ongoing treatments.

Dr. Carlos Wesley, a hair restoration surgeon in Manhattan, said that women in his practice respond better to P.R.P. than men do, which may have something to do with the fact that women with genetic hair loss tend to have more inflammatory cells around the follicles. From 2013 to 2014, he said, he had an 83 percent increase in female patients, in part because of P.R.P.

The main type of hair loss in women is the same as it is men. It's called androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic "M" shape; hair at the top of the head also thins, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman's hairline rarely recedes, and women rarely become bald.


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.
For those of you who only check the Updates page, there was a new Brotzu Check-In article published yesterday. Giovanni Brotzu will be presenting data pertaining to his lotion’s use in androgenetic alopecia at an Italian hair research Congress this Saturday, April 14th. We hope to see photo results from the presentation. Check back to the Brotzu article next week for updates.
Regarding the RCH news, is your source more reliable than Lee Buckler since he seems to know more about RCH than Lee buckler himself. Recently, Lee Buckler tweeted “We anticipate seeing data from the RCH-01 study in Japan sometime before year-end but the real answer is whenever the investigators/hospitals in charge of the trial (not us) decide to release the data once it ready”
Because there are a lot of products in the crowded marketplace that claim they can regrow your hair, it’s a necessity for the legitimate ones to have disclaimers on their websites. Essentially, these disclaimers state that the products haven’t been evaluated by the FDA and so can’t be guaranteed to provide the benefits they claim to provide—at least not from the standpoint of the regulators. 

Over the past year, the Hair Restoration Laboratories’ Professional Strength DHT Blocking Hair Loss Shampoo (and accompanying DHT Blocking Hair Loss Conditioner) has been a top seller on Amazon and many other sites. Combined, the daily use Shampoo and Conditioner has more DHT blockers than any shampoo/conditioner set presently available. Among the key DHT Blockers in this set are: Caffeine, Saw Palmetto, Black Cumin Seed Oil, Cayenne Fruit Extract, Rosemary Leaf Oil, Pumpkin Seed Oil, Green Tea Leaf Extract, Pea Extract and many more. By helping to block DHT, they should be a great asset in helping to halt the miniaturization of the hair follicles and regrow healthier and thicker hair.

Clearly, minoxidil is not a miracle drug. While it can produce some new growth of fine hair in some — not all — women, it can't restore the full density of the lost hair. It's not a quick fix, either for hair loss in women . You won't see results until you use the drug for at least two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you'll need to keep using it to maintain those results. If you stop, you'll start to lose hair again.
Therapeutic advanced formula unclogs pores and removes DHT while moisturizing the scalp and stimulating circulation and hair follicles. This Scientific complex shampoo, with olive oil and argan oil, promote manageable hair without the flakes and itchy that comes with dandruff. Our maximum strength anti itch formula clarifies the skin for incredible body in your hair while stopping the thinning of hair. Our formula recipe promotes hair growth and regrowth of strengthened, shiny, thick hair.
DH—or as it’s less commonly known, Dihydrotestosterone—is the bodily byproduct that (in the TL;DR explanation) shrinks hair follicles until they’re so thin and short they just fall out. Keranique’s unique blend includes a DHT-inhibitor, which penetrates the scalp and follicles to deliver a keratin amino complex, developed to add resilience and protection. This one can contribute to improved texture, healthier strands, and yes, even new growth.

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.


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.
There have been recent discussions on Italian hair forum websites that indicate the Brotzu lotion may very well be moving ahead and preparing for imminent release. After commenter “Ahmed” brought it to my attention, I went back to check the Bellicapelli forum (the site which had the information on the Brotzu presentation at the Sitri Congress in April). I found a response from user “carlitos71” on this page which seems to display the new theories on the Brotzu lotion.
The third and fourth stages are known as telogen and exogen, respectively. In telogen, the hair is supposed to be at "rest" until it finally detaches itself from the follicle and enters the exogen or shedding stage. Once the hair is detached from the follicle, the follicle remains inactive for about three months, after which a new cycle begins again.
Important clues to the etiology of different patterns and types of hair loss are listed in Table 1 and Table 2. Hair that comes out in clumps suggests telogen effluvium. Systemic symptoms such as fatigue and weight gain suggest hypothyroidism, whereas a febrile illness, stressful event, or recent pregnancy may account for the diffuse hair loss of telogen effluvium. The use of hair products such as straightening agents or certain shampoos suggests a diagnosis of trichorrhexis nodosa. A family history of hypothyroidism may warrant laboratory testing for this condition, whereas a family history of hair loss supports the diagnosis of androgenetic alopecia.

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 other main hair-loss treatment that was recommended by all four dermatologists I interviewed is finasteride, often called by its brand name Propecia. This FDA-approved medication is only available with a prescription, but these days, it’s found as a generic and ordered online after a virtual consultation, through start-ups like Hims, Keeps, and Lemonaid.

In the nineteen-forties, a Brooklyn anatomist named James Hamilton studied prisoners in Oklahoma who, having been convicted of sexual assault, were castrated. Hamilton identified testosterone as the root of hair loss, and showed that men castrated before or during puberty did not go bald. He then injected groups of castrated adult men with testosterone and—duly, cruelly—watched their hair fall out.


Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)
Men’s Rogaine Extra Strength Solution is the liquid version of our top pick. It didn’t make our final cut because it includes propylene glycol, which causes irritation in roughly one-third of its users. With that said, Dr. Wolfeld finds that it can be even more effective in practical daily use. In his experience, “the solution can penetrate and get into your scalp a little bit better” than the foam — especially if you’re not taking the time and effort to apply the foam correctly. This seems crazy to us since the foam so quickly dissolved into a liquid in our tests, but if you’re worried, try a one-month supply of the liquid and make the switch to foam if you notice any irritation. 

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.
“People have been trying to sell a baldness cure since the beginning of civilization,” Kuntzman explained. “And the methods by which they try to sell that cure have not changed dramatically. These new companies, they’re trotting out the same promises that people trotted out in Roman times, when they said, ‘Use this hippopotamus fat to grow hair on your head!’ ”

Aclaris Therapeutics, the company who acquired the rights from Angela Christiano to use JAK inhibitors in alopecia disorders, is currently involved in a wide range of alopecia trials. The company has multiple ongoing trials for alopecia areata, including a trial for eyebrow regrowth, and also a new trial planned for AGA or androgenic alopecia. Full article here.


There have also been studies on the effects of 1% pyrithione zinc shampoo and a 5% minoxidil solution. In one study, 200 men between the ages of 18 to 49 who experienced baldness between type III and type IV on the Norwood scale were given this treatment for a six-month period. They found that minoxidil, when used on its own, was approximately twice as powerful as pyrithione zinc at stimulating hair growth, but that both products were successful at increasing the amount of visible hair when used over a 26-week period.


The physical examination should focus on the hair and scalp, but attention should be given to physical signs of any comorbid disease indicated by the review of systems. If only the scalp is involved, the physician should look for typical male or female pattern to determine the presence of androgenetic alopecia. Whole body hair loss is consistent with alopecia totalis. Dry, broken hair suggests trichorrhexis nodosa, whereas scaling, pustules, crusts, erosions, or erythema and local adenopathy suggest infection.
However, this partnership ended in 2007 due to potential safety issues since SHH can potentially also cause basal cell carcinoma cancer. P&G was not willing to continue with the drug development work, since even a very minimal risk of developing cancer is not worth it for treating a cosmetic problem such as hair loss (at least in the eyes of government). Interesting comment from the at-the-time CEO of Curis:
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.
Aside from medication and lasers, some opt for hair transplants — a procedure where hairs are removed from another part of your body and then transplanted to the thinning or balding areas. Does it work? In a word, yes. Research suggests that most hair transplant recipients report are "very satisfied" with their results. While successful, transplants are also far more expensive than medications, foams, or lasers with costs averaging anywhere from $4,000 or $15,000.

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.
A number of other shampoo and conditioner products are available that seem to be very popular with men and women suffering from thinning hair. These include a range of Shapiro MD and Nioxin hair loss shampoos. Also popular are Keranique and the uniquely named Bumble and Bumble thickening shampoo. Some of these do not have a sufficient number of reviews for me to consider adding them to my list of top shampoos.
If you’re looking for an au naturel option, look no further. This shampoo has been an Amazon best seller since 2012. It smells great, lathers well, and has no harsh chemicals mixed in. Pura d’or has elimated all the bad stuff from this shampoo—no Parabens or SLS. It does have a ton of good stuff too! Practically every clinically proven natural ingredient that aids against hair loss is packed into this shampoo. Nettles extract, he shou wu (fo-ti), argan oil, B vitamins, biotin, and saw palmetto.
Pura d’or also have a hair loss conditioner compliment to this shampoo but we think it’s a bit overkill to use both(as a bottle of this stuff runs on the pricey side)—but if you love the shampoo the conditioner is also a very popular product that couldn’t hurt. Leave it in for about 3 minutes and let your scalp absorb all those vitamins and minerals.
DH—or as it’s less commonly known, Dihydrotestosterone—is the bodily byproduct that (in the TL;DR explanation) shrinks hair follicles until they’re so thin and short they just fall out. Keranique’s unique blend includes a DHT-inhibitor, which penetrates the scalp and follicles to deliver a keratin amino complex, developed to add resilience and protection. This one can contribute to improved texture, healthier strands, and yes, even new growth.

Due to the concern of several readers, I’ve removed the link to the new Trinov website that has popped up on the net. For now, the website only contains an email address subscription box which really poses no issue to anyone who subscribed. At this time, it’s not confirmed who the actual owner of the new Trinov site is, so use your discretion until we find out more regarding this matter. Until more information is known the website will not be shared on Follicle Thought.
Hey there, I'm Shawn, the founder of Tools of Men! This site was created to help out other guys by teaching them proper grooming habits and the basics of sensible style. We try to make things here a bit of fun while giving you clear info. If you want to get in touch with us, drop us a line on the contact page or via social media. Thanks for checking out the site - and make sure to come back again!
Lipogaine is a complete hair care system to treat most hair loss issues. The Big 5 Shampoo is a blend of Biotin, caffeine, Argan oil, Castor oil, and other powerful ingredients. They use only premium organic and natural DHT blocking ingredients with no sulfates or parabens. Lipogaine is for both men and women and all hair types, including color-treated hair. They also have a Minoxidil product and a fantastic 90-day money-back guarantee, including shipping, which is pretty rare.

Our runner-up Clinical Effects Hair Therapy was a very close second to our top pick and our Best Value choice. Several of our testers felt that this was the overall best shampoo both in how their hair felt as well as the light scent.  We feel that it is the best overall value in this category as you can buy it at a price significantly less than the competition.  Clinical Effects is for both men and women and comes with an amazing 90 Day guarantee that is also the best in this category. We highly recommend it if you’re looking for a less expensive option to Shapiro MD.  They have fantastic customer service and stand behind all of their products.


Rogaine and Propecia, the only commercial hair-loss products that have ever been proven to work, were both discovered accidentally. Rogaine, a topical product known as minoxidil in its generic form, was originally developed as a blood-pressure drug. Scientists do not fully understand its efficacy, but the working theory is that minoxidil protects the dermal papilla from DHT. Propecia, or finasteride, was originally developed as a treatment for enlarged prostates. It inhibits the creation of DHT. Both products have drawbacks. In order to be effective, minoxidil must be applied daily. Because of the hormonal imbalance that finasteride causes, women can take it only if they are postmenopausal. If you stop taking either drug, you will quickly lose the hair you would have lost in the duration of your usage. (Recently, on the actor Dax Shepard’s podcast, Ashton Kutcher confided that he’d stopped taking finasteride. With awe, Shepard said, “I just think that’s so risky of you.”)
“Let’s see, how did it work with Jason?” Farrell said, when I met him, in a sun-drenched suite on the thirty-fourth floor of the Marriott in downtown Manhattan. He was wearing all black: black boots, black-leather bomber jacket, perfectly snug black T-shirt. Tattoos poked out from his jacket sleeves, down to the tops of his hands—black roses and black birds and things. His dark, curly hair bounced past his chin. “I believe he just called up and made an appointment! I don’t consider myself a hair guy to the stars at all. I work with regular people throughout the world.”

Aclaris Therapeutics, the company who acquired the rights from Angela Christiano to use JAK inhibitors in alopecia disorders, is currently involved in a wide range of alopecia trials. The company has multiple ongoing trials for alopecia areata, including a trial for eyebrow regrowth, and also a new trial planned for AGA or androgenic alopecia. Full article here.
The thing is that these big drug companies have shelled out millions and even billions of dollars to research, develop, market and then sell a drug-based product that consumers want. Therefore, they will do everything in their power to protect and guard their products against any drug-free alternatives. The kicker is even if said alternatives are cheaper and safer for consumers, while also achieving the same goals for them! This is the crux of claim enforcement, which is really about claim ownership and claim protection from the perspective of the big drug companies.
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“It all started with a particular drug, Cyclosporine A, which is an immunosuppressant,” Hawkshaw explains. “It’s typically given to transplant patients to stop them rejecting new organs post-surgery and it’s been observed that it enhances hair growth. But the thing is, you don’t really want to give this to patients normally because you don’t want to suppress their immune system. So, I used that drug to treat human hair follicles in the lab to try and identify how it actually worked.”
Lipogaine is a complete hair care system to treat most hair loss issues. The Big 5 Shampoo is a blend of Biotin, caffeine, Argan oil, Castor oil, and other powerful ingredients. They use only premium organic and natural DHT blocking ingredients with no sulfates or parabens. Lipogaine is for both men and women and all hair types, including color-treated hair. They also have a Minoxidil product and a fantastic 90-day money-back guarantee, including shipping, which is pretty rare.
Bumble & bumble had fine-haired beauties in mind when creating this super-moisturizing (but still super-weightless) formula. The shampoo’s trifecta relies on damage-controlling panthenol (or you as you may know it, vitamin B5), strengthening wheat protein, and scalp-loving, deep-conditioning aloe vera. Strands are left prepped for big, voluminous blowouts or to be hand-tousled for texture, movement, and shine.

“We are extremely pleased with the continued development of the patent portfolio we exclusively licensed from Columbia.  This new issuance continues to expand the breadth and depth of our JAK inhibitor intellectual property portfolio covering methods of use for certain JAK inhibitors for the treatment of hair loss disorders. The issuance of this patent is another step in the development of a robust patent portfolio relating to JAK inhibition and hair loss,”
Contact immunotherapy. Another drug that can be administered for cases of alopecia areata is contact immunotherapy and is recommended for severe cases. Diphenylcyclopropenon (DPCP) is applied on the scalp every week, and the dosage of the drug is increased over time until a mild allergic reaction is observed, which signals that the drug is taking effect. Regrowth may be observed within three months from the beginning of treatment.
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.

Another shampoo which is part of a “system” that includes conditioner and serum. And it’s yet another shampoo which has worked well on its own for many people. The HairGenesis shampoo (and the other products) contains a proprietary formula that is patent-pending, and the company says that the goal of the shampoo is to prepare hair for “maximum growth potential.” It also uses a lot of impressive sounding phrases to describe what the HairGenesis shampoo does.


While the drug is generally safe for use, some possible side effects are mild irritation of the scalp, dryness and growth of hair on some parts of the body, especially the sides of the face and hands. In some cases, you might observe some increased hair loss around the first few days of use. If the hair fall continues after two weeks upon application of minoxidil, stop the treatment first and see a doctor.
Regarding the RCH news, is your source more reliable than Lee Buckler since he seems to know more about RCH than Lee buckler himself. Recently, Lee Buckler tweeted “We anticipate seeing data from the RCH-01 study in Japan sometime before year-end but the real answer is whenever the investigators/hospitals in charge of the trial (not us) decide to release the data once it ready”
At the Sanford-Burnham Medical Research Institute, they showed that stem cells derived from human skin to grow hair when grafted onto the skin of mice. A paper describing this research, which was published on January 21st 2015 can be found here in the PLOS One medical journal. Dr. Alexey, a member of the research team made the following written statement: “Our stem cell method provides an unlimited source of cells from the patient for transplantation and isn’t limited by the availability of existing hair follicles.” Once successfully developed, this could transform a fully bald man or woman to the head of hair they had as a teenager. The main challenge now will be replicating their results in large-scale human trials.
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.
Drugs normally used for rheumatoid arthritis and bone marrow cancer, they are now being studied for their uses as a hair growth medicine. These are a new class of medicines labeled as JAK inhibitors. In one study, 6 out of 9 patients dramatically went from bald to a full head of hair after taking Ruxolitinib for 5 months. In another study several subjects were able to regrow full heads of hair. Unfortunately, sustained use of such drugs will have severe side effects. Many of these concerns would be side stepped if a topical formula could be developed. Researchers at the Department of Dermatology and Genetics and Development at Columbia University Medical center are now studying other JAK inhibitors in placebo controlled studies.
Best hair loss treatment shampoo for women and men is made with natural, herbal ingredients that promote a healthy scalp and hair follicles. We use no sulfates, no parabens and no harmful ingredients. Our formula is safe for color treated hair as well as processed and natural hair. We avoided using any additives instead opting for ingredients found in nature so our hair is safe for all hair types and textures, no matter your age. Our dandruff and hair loss prevention shampoo goes to the root of the issue repairing the scalp instead of just covering the symptoms.
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.
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