Do Hair Loss Treatments Actually Work?

In the United States, treatments for hair loss are a $3.6 billion industry with products ranging from supplements to shampoos, laser-producing helmets, and even surgery. But do any of these treatments actually work?

What Causes Hair Loss?

Our hair grows in a cycle with three distinct phases.

First, hair grows and gets longer in the anagen phase which can go on for several years. Then, during the ~10-day catagen phase, hair stops actively growing and separates from its follicle, which is what holds the hair in place beneath the skin. Finally, in the telogen phase, the follicle goes into rest mode for several months until the hair falls out. Then, the process starts anew.

The average person loses 50 to 100 hairs per day naturally due to this cycle. But if the process is interrupted at any stage—for example, if the follicle doesn’t come back out of resting mode or starts to shrink—hair loss and hair thinning can result. Interruptions to the cycle can be caused by hormones, stress, poor diet, chemical hair treatments, certain medications, and, of course, good ol' genetics.

The average person loses 50 to 100 hairs per day naturally due to this cycle.

What Is Androgenetic Alopecia?

The most common form of hair loss is androgenetic alopecia, or, in other words, male or female pattern baldness or hair loss. Androgenetic alopecia is genetic and affects an estimated 50 million men and 30 million women in the United States. Among white women in the U.S., an average of 19% are affected by female pattern hair loss, but that percentage increases with age. The prevalence is nearly doubled in Australia at 32% and much lower in Korea and China at < 6%. As of 2015, no studies had been done on the prevalence of female pattern hair loss in Brazil or Africa.

Male pattern baldness is linked to a sensitivity to the hormone dihydrotestosterone and usually manifests as a receding hairline or ring of missing hair. Female pattern baldness instead typically causes the hair to thin all over the scalp but not fall out.

Another fairly common form of hair loss is alopecia areata, which usually presents as patches of hair loss over the scalp and is autoimmune related. In autoimmune conditions, the body’s immune system attacks bodily tissues even when they are healthy. In the case of alopecia areata, the hair follicles are prevented from growing new hair.

A more temporary form of hair loss is telogen effluvium or when hair follicles get stuck in the telogen or resting phase and stop growing new hair. Telogen effluvium can occur three months after a significant medical event like childbirth, surgery, or a high fever, but can also be caused by a thyroid imbalance or iron deficiency. Certain medications like blood thinners and birth control pills are also linked to this form of hair loss.

To determine the cause of your hair loss, a doctor will typically conduct blood work to diagnose any missing nutrients or autoimmune disorders, take down your family history, study the pattern of the hair loss (in other words, is it a receding hair line or patchier in nature?) and potentially take a scalp biopsy.

Which Hair Loss Treatments Work?

The effectiveness of a hair loss treatment depends strongly on what is causing the hair loss and the list of potential causes is a long one. Not only does the treatment have to address the underlying cause of the hair loss, or alopecia, but the ability to correct different forms of hair loss itself varies. Some forms of hair loss are more easily addressed than others.

If hair loss is due to stress, nutrient loss, or lack of sleep, these causes can be temporary and hair growth can return once these triggers are addressed. Similarly, treatment for an autoimmune disorder or thyroid imbalance as the root cause of hair loss can fix the hair loss problem at the same time. The same is true for medicines or treatments that cause hair loss, for example, chemotherapy or tamoxifen for cancer treatment. In almost all cases, hair grows back in 2 to 6 months once the medication is no longer being taken. Bald patches can also occur with tight hair styles like ponytails or braids, a condition known as traction alopecia which can often be corrected by a change in hair style.

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There are a few drugs marketed toward recovering hair lost due to male or female pattern baldness. Minoxidil, a drug used to treat high blood pressure but also the drug used in Rogaine, can be applied topically to the scalp and works to stimulate hair growth by activating hair follicles to keep them in the growth cycle longer. The drug is shown to increase hair density and at least moderate hair regrowth in women and men. However, for women with hair loss due to an autoimmune disorder, minoxidil may only maintain existing hair without any benefits of regrowth. Some clinical trials suggest higher concentrations (i.e. 5% over 2%) are more effective but others do not. Continued use is required to maintain the drug’s benefits.

The drug finasteride (marketed under the name Propecia) works by blocking the creation of certain hormones or enzymes that can cause male pattern baldness and is approved only for use by men. Trials show that it noticeably thickens hair in ~50-60% of patients and in some cases may even lead to regrowth, but the medication must be taken continuously to maintain these results.

For alopecia areata, injections of corticosteroids at the bald patch are often used successfully to stimulate hair regrowth. Studies suggest that regrowth is possible, particularly in patients who have had limited scalp hair loss over shorter periods of time, but the literature so far lacks randomized controlled trials.

In hair transplant surgery, doctors remove hair follicles from parts of the scalp that are still actively growing hair and implant them in areas that are sensitive to hair loss. The procedure can be successful at reducing the appearance of bald patches but if the reason for hair loss is genetic, the hair’s return is usually only temporary.

New therapies, like those that use lasers to stimulate hair thickening show promising anecdotal evidence but not enough clinical trial data yet exists to verify their effectiveness or to know the long-term effects of such treatment.

Do Supplements Work to Treat Hair Loss?

There are many, many vitamins and supplements that claim to help regenerate lost or thinning hair, whether they are taken orally or contained within shampoos. They typically include vitamins A, C, or E, biotin, manganese, selenium, fish oil, or flaxseed oil. In general, the Food and Drug Administration in the U.S. does not monitor the effectiveness of such supplements. So FDA approval for a supplement does not actually mean the supplement does what it claims to do. (And current leaders in the FDA want to move more and more drugs and other products into this less monitored category.)

According to a study conducted by Consumer Reports, there is little to no evidence that supplements make a difference in hair regrowth. The few supplement success stories usually involve people who have a measured deficiency in one of the vitamins, like biotin, but such deficiencies are rare and usually arise from long-term antibiotics use or from taking anti-seizure drugs.

Hair loss treatments are an active area of research given the large fraction of the global population that are affected by hair loss. Some recent studies have seen success in identifying specific proteins that are linked to hair loss or using platelet-rich plasma injections of a patient’s own blood and others have even linked a chemical used to cook fast food fries to hair follicle production. So although we may not have figured out a straightforward fix yet, one may be on the horizon. 

Until next time, this is Sabrina Stierwalt with Everyday Einstein’s Quick and Dirty Tips for helping you make sense of science. You can become a fan of Everyday Einstein on Facebook or follow me on Twitter, where I’m @QDTeinstein. If you have a question that you’d like to see on a future episode, send me an email at everydayeinstein@quickanddirtytips.com.

Image courtesy of shutterstock.