Hair loss is a common experience, affecting millions of people at some stage of life.
By age 65, about 53% of men and 40% of women will experience hair loss — a very personal journey that can have real consequences for mental health and self-esteem.
But hair today may not be gone tomorrow.
Many forms of hair loss can be treated, though wading through the sea of options available in this growing landscape can be overwhelming, especially with social media hacks and influencer recommendations adding to the overload.
Ultimately, there is no one-size-fits-all solution, as many different triggers can make your hair thin or fall out. That’s why being seen by a board-certified dermatologist for a formal diagnosis is a non-negotiable when addressing any hair loss concern.
Read on to learn which hair loss treatments actually work, which popular remedies may not be worth the hype and the biggest mistake people make on their hair growth journeys.
The best medical options aren’t always FDA-approved for hair loss
Androgenetic alopecia — also known as male- or female-pattern baldness — is the most common cause of hair loss worldwide, but there are only a few FDA-approved therapies for it.
For men, two FDA-approved treatments are available: topical minoxidil and oral finasteride, the latter commonly sold under the brand name Propecia. For women, only topical minoxidil is FDA-approved for hair loss.
FDA-approved treatments have undergone rigorous testing for specific uses. However, several treatments that aren’t FDA-approved specifically for hair loss are widely used off-label and have evidence supporting their effectiveness.
These include:
- 5-alpha reductase inhibitors, or 5-ARIs, including finasteride and dutasteride: These are used off-label to address female pattern hair loss, particularly in postmenopausal and non-pregnant women. Dutasteride is also used off-label to treat male AGA.
- Bicalutamide and spironolactone: These are used off-label to treat AGA in women, especially those with polyendocrine metabolic ovarian syndrome, or PMOS (previously named PCOS).
- Oral minoxidil: Currently, an immediate-release tablet (an extended release version is in Phase 3 clinical trials now), this has demonstrated significant benefits over the years, with multiple studies showing that low doses can be effective for many patients with AGA.
Natural hair loss remedies
Some natural therapies have varying levels of evidence behind them, although they generally aren’t as well supported or effective as prescription treatments prescribed by a board-certified dermatologist.
Three botanical ingredients are considered natural 5-ARIs: saw palmetto, pumpkin seed oil and rosemary oil.
A small study on topical rosemary oil found it performed similarly to 2% minoxidil when applied daily. Saw palmetto also has some evidence supporting its use, while oral pumpkin seed oil has been studied in a small male randomized controlled trial and was found to be beneficial.
Scalp oils may be more practical for people with curlier hair, which is more prone to dryness, than for someone with pin-straight hair who may find daily scalp oiling messy and difficult to maintain.
People who are trying to conceive, pregnant or breastfeeding should avoid 5-ARIs and other topical or oral therapies also containing anti-hormonal agents. Always consult your medical provider prior to starting any new therapies.
Massages and high-tech tools
Scalp massages may temporarily increase blood flow to the scalp, but there isn’t significant evidence that they meaningfully improve hair growth.
People with scarring alopecia should also avoid rigorous scalp massages because trauma to the scalp could potentially activate inflammation.
Red light and infrared light therapy have somewhat more promising evidence. There is data suggesting they can be beneficial for AGA, and many dermatologists combine low-level light therapy with prescription treatment to help optimize results.
Additional non-medication treatments include platelet-rich plasma injections and FoLix, the first and only FDA-cleared fractional laser for hair loss.
What results should you realistically expect?
Most people won’t recover the head of hair they had in their youth, but many can expect some degree of improvement.
Dermatologists typically measure improvement as mild, moderate or great. Another important outcome is stabilization, which can be assessed through hair density and hair thickness. Contrary to common belief, hair shedding is not a validated method of hair assessment and not necessary an indication of hair loss.
How much one person can expect also depends heavily on the type of hair loss, since it can be caused by different conditions.
For typical pattern hair loss, stabilization is a reasonable expectation for many treatments, along with some degree of regrowth.
Many patients can expect to see improvement within four to six months. Ultimately, however, the amount of improvement varies from person to person.
The biggest hair loss mistake? Waiting too long
When it comes to hair loss, time is of the essence. People should seek treatment as early as possible because earlier intervention can give them a better chance of success.
It is imperative to have hair loss diagnosed by a board-certified dermatologist to determine what is actually causing it. Sometimes, it can be more than one condition.
For those who have excess hair shedding, a dermatologist may order blood tests to look for underlying causes or nutritional deficiencies. If an underlying issue is contributing to hair loss, treating it may be an important part of the overall treatment.
Kristen Lo Sicco, MD, is a board-certified dermatologist, hair loss specialist and chief of the Skin and Cancer Unit at NYU Langone Health. She conducts clinical research and novel therapeutic trials with a focus on alopecia.
Jerry Shapiro, MD, is a board-certified dermatologist and founding director of the Hair and Scalp Disorder Clinic at NYU Langone Health. He has published over 350 peer reviewed scientific publications over the past four decades.
