Comprehensive Treatment Guide for Male Hair Loss

The internet is flooded with a myriad of hair loss treatments, each claiming to be the ultimate solution. However, the vast majority of these offerings are nothing more than commercial gimmicks aimed solely at increasing the revenue of the companies selling them. With brand names like Regenepure DR and Neofollics, ordinary products are transformed into "the latest innovations." Phrases such as "This shampoo contains a variety of proven active ingredients that may improve hair growth and inhibit hair loss" make it seem like the effectiveness of these products is undisputed [1†source].

The reality, however, is that the efficacy of these treatments is often unsubstantiated. Companies use terms that suggest efficacy but lack specific data to support their claims. The health claims thrown around make it challenging to distinguish between sense and nonsense, and they can be frustrating for consumers seeking genuine solutions.

Purpose

The purpose of this guide is to provide an overview of hair loss treatments that are scientifically proven to work and those that lack substantial evidence. Readers can consider this guide as comprehensive, and treatments not included should be regarded as ineffective.

To assess each treatment, we have collected and analyzed multiple scientific studies. A treatment assessed as ineffective is indeed ineffective, and vice versa. To keep the guide concise and readable, we have summarized the analysis for each treatment in a few sentences. For a complete overview of the research results, readers can refer to the attached articles and scientific references.

Medical Treatments

Finasteride

A large number of studies, including 16 placebo-controlled trials, are available on finasteride. The quality of these studies is high [2†source, 3†source].

The primary function of finasteride is the prevention of disease progression (stopping hair loss) by reducing the amount of dihydrotestosterone (DHT). A dose of 1mg/day provides a DHT reduction of approximately 70% [4†source]. In two long-term studies spanning 10 years, finasteride stopped hair loss in 86% and 99.1% of men, confirming its long-term effectiveness [5†source, 6†source].

Dutasteride

A large number of high-quality studies are available on dutasteride [7†source]. The effect of dutasteride is similar to finasteride, reducing the amount of DHT by about 84% at a dosage of 0.5mg/day. Dutasteride is slightly more effective than finasteride, but the risk of side effects is also slightly higher [8†source].

Long-term studies on dutasteride are limited. Studies of 1 and 3 years seem to confirm its safety and efficacy, but further follow-up studies are needed [9†source, 10†source]. Despite its effectiveness, dutasteride is not yet approved as a treatment for hair loss, with no clear reasoning provided.

Minoxidil

There are numerous studies on minoxidil, including 25 placebo-controlled trials. The quality of these studies is medium to high [11†source]. According to the studies, minoxidil caused an increase in hair growth and hair thickness, with an effectiveness of over 60%. Peak efficacy was reached after 12 months [12†source].

Long-term studies show a decrease in effectiveness after 2 to 3 years, after which the hair loss process continues, but at a slower rate [13†source]. The primary function of minoxidil seems to be slowing down the hair loss process rather than stopping it entirely. The achieved stabilization during the first 2 years is temporary.

Herbal Extracts and Preparations

The studies that researched the effectiveness of herbal extracts for treating hair loss are scarce and generally of low quality. Our findings are discussed below.

Saw Palmetto

There is a limited number of studies on saw palmetto for hair loss. A single high-quality study from 1996 examined the effect of saw palmetto on benign prostatic hyperplasia (BPH), but its effectiveness as a treatment for hair loss was not proven [14†source]. The quality of other studies is low, with small study groups, high risk of bias, and other limitations [15†source].

The ability of saw palmetto to reduce scalp-DHT has not been proven, and data on this is lacking. Saw palmetto as a treatment for hair loss is therefore unlikely [16†source].

Caffeine

There are a limited number of studies available on caffeine for hair loss. The effectiveness of caffeine on the hair follicle has been studied in laboratory settings only. In vivo studies measured the effectiveness of caffeine using the hair pull test, a non-standardized method that does not provide insights into the effect on hair loss [17†source].

Moreover, the way caffeine is applied in the studies does not correspond to real-life conditions. The penetration and effect of caffeine in the hair follicle have not been measured in vivo (i.e., in living human subjects). The efficacy of caffeine shampoo as a treatment for hair loss has not been proven [18†source].

Ginseng

There is a limited number of studies on ginseng for hair loss. Most studies were conducted in laboratory settings that do not correspond to real-life conditions. In vivo studies are scarce and have a high degree of subjectivity. Large placebo-controlled studies are lacking, rendering the results unreliable [19†source].

Ginkgo Biloba

Very few studies have investigated the use of ginkgo biloba for hair loss. The relationship between ginkgo biloba and DHT has not been investigated, suggesting that its ability to stop hair loss is unlikely [20†source].

Studies that have examined the effect of ginkgo biloba for promoting hair growth are of low quality, lacking objective measuring instruments and data on the magnitude of the effect (if any) [21†source].

Marine Extract and Silica Component

There is a very limited number of studies on marine extract and silica components for hair loss. The study that noted a positive result dates back to 1992 and has a high risk of bias due to a small control group and a non-randomized setting [22†source]. The relationship with DHT has not been investigated, suggesting that the ability to stop hair loss is unlikely.

Vitamins

Vitamin A

A limited number of studies are available on vitamin A for hair loss. The relationship with DHT has not been studied, making vitamin A an unlikely means to stop hair loss [23†source].

The effectiveness of vitamin A in promoting hair growth has not been proven. In fact, high doses of vitamin A can cause hair loss and thinning. Vitamin A supplementation is not recommended [24†source].

Vitamin B

The vitamin B complex includes eight water-soluble vitamins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), vitamin B6, biotin (B7), folate, and vitamin B12.

Vitamin B7 - Biotin

Studies on biotin for hair loss are limited. Biotin is effective for treating hair loss only if it is caused by an inherited enzyme deficiency in biotinidase or holocarboxylase synthetase, a rare genetic disorder occurring in 1 in 60,000 individuals [25†source].

Biotin deficiency in the healthy population has never been reported. This is because about 50% of the required amount of biotin is produced by intestinal bacteria, making it highly unlikely to become biotin deficient [26†source]. Therefore, supplementing biotin is not recommended, as its benefit is limited to those with a rare genetic disorder.

Warning: Supplementing biotin may cause false-low troponin levels, a biomarker for the diagnosis of heart attacks, potentially leading to missed diagnoses [27†source].

Vitamin C

There is no data available on the efficacy of vitamin C as a treatment for hair loss.

Vitamin D

Some studies are available on vitamin D for hair loss. Supplementation of vitamin D for the treatment of hair loss was found to be ineffective [28†source].

Some studies have measured lower vitamin D levels in patients with alopecia areata (AA), an autoimmune disease. The relationship is possible but uncertain. An abnormality in the vitamin D receptor is speculated. However, the low vitamin D levels are probably a consequence of AA rather than a cause [29†source].

Vitamin E

Very few studies are available on vitamin E for hair loss. The effectiveness of vitamin E for the treatment of androgenetic alopecia (AGA) has not been investigated. The focus of the studies was on the treatment of alopecia areata (AA) [30†source].

Higher values of oxidative stress biomarkers and lower concentrations of antioxidants are measured in patients with AA. The possible role of vitamin E for the treatment of AA is suspected due to its antioxidant properties. However, there is no data available showing vitamin E to be effective for genetic hair loss or alopecia areata [31†source].

Minerals

Zinc

Only a handful of studies are available on zinc for hair loss, and their quality is low, with small control groups, high risk of bias, and other limitations [32†source].

Severe zinc deficiency can cause hair loss, but it is rare. The effectiveness of zinc supplementation in the healthy population has not been proven, as data is lacking [33†source].

Iron

The number of studies on iron supplementation for hair loss is limited. Iron supplementation in the healthy population has not been investigated, with the focus being on iron deficiency [34†source].

Iron supplementation in men with AGA had no effect, while in women, the results were contradictory. The effectiveness of iron supplementation for hair loss is therefore unclear [35†source].

Surgery and Laser Therapy

Hair Transplants

In a hair transplant procedure, hair follicles are taken from the donor area and used to create a new hairline. The transplanted hair follicles are DHT-resistant, and the new hairline is permanent [36†source].

The result depends on the expertise of the surgeon, with patient satisfaction being higher for follicular unit extraction (FUE) than follicular unit transplantation (FUT) [37†source]. However, for treating hair loss, hair transplantation is ineffective as it is a repair technique, not a prevention technique.

A hair transplant is therefore ineffective as a treatment for hair loss itself [38†source].

Laser Therapy

Studies on low-level laser therapy for hair loss are limited, and the quality of the available studies is weak. In some studies, the manufacturer was the sponsor, introducing potential bias. As a result, the results are unreliable [39†source].

The efficacy of low-level laser therapy for hair loss has not been demonstrated conclusively [40†source].

Conclusion

In the ever-growing market of hair loss treatments, it is crucial to separate fact from fiction. This guide provides a comprehensive overview of scientifically proven and unproven treatments, enabling readers to make informed decisions. While medical treatments like finasteride, dutasteride, and minoxidil have demonstrated efficacy, many herbal extracts, vitamins, and minerals lack substantial evidence to support their claims. It is essential to approach hair loss treatments with a critical eye and rely on scientific research rather than unsubstantiated claims.