Health

Evidence-based tips for hair loss

These are the things you can do if hair loss has started, but you have not gone completely bald yet.

Please keep in mind that these directives are not dogmatic and not set in stone. They are, however, contextual at times.

This is the first part of my article series on hair loss. It covers the things you can do if hair loss has started, but you have not gone completely bald yet.

The second part deals with how to make peace with going bald irreversibly.

The best time to take care of your hair is before you start losing it. A lot of people wait too long. If you're in your early or mid-twenties, that's a good time to start to preserve the follicles on your scalp.

Of course, if you're at a later stage in life, it's still better to do something than nothing. Just know the regrowing hair is harder if not almost impossible compared to preserving hair.

These tips might help

Use rosemary oil

Studies have shown that rosemary oil is as effective as Minoxidil 2 % (which we'll discuss later) in treating androgenetic alopecia hair production. Apply it to your scalp, and keep doing so for at least 6 months. After 3 months, no significant results were noticeable. After 6 months, participants experienced a significant increase in hair count. [1]

Rosemary oil might work by widening the blood vessels in the scalp, thus improving supply with oxygen and nutrients to the hair follicles. It also might inhibit the enzyme 5 alpha reductase and that decreases DHT in the blood stream. DHT is a contributor to hair loss. So this effect is very similar to what Finasteride does (which we'll also discuss later). Rosemary oil also might have anti-inflammatory, anti-oxidant and anti-microbial effects.

Apply pumpkin seed oil to your scalp

Much like rosemary oil, pumpkin seed oil has been shown to block the enzyme 5 alpha reductase. So its effect is similar to Finasteride, but without any side effects. [2]

Eat a healthy diet

Consuming a diet rich in raw vegetables, fresh herbs and potentially soy decreases the risk of hair loss. Providing your body with the healthy nutrients it needs to function is always a good idea, just like keeping your gut bacteria happy. Read "What to eat for longevity" for a list of the healthiest foods you can eat. [3]

Eat pumpkin seeds, peppers and soy

In a randomized, double-blind, placebo-controlled trial, researchers gave 76 male participants 400 mg of pumpkin seed oil in capsules every day for 24 weeks. That is like eating two pumpkin seeds a day. Compared to the placebo group, participants in the pumpkin seed oil group had a 40% increase in hair count and reported a higher subjective satisfaction with the result. A handful of pumpkin seeds is also beneficial for prostate health (if you have one).

Another study found that capsaicin and isoflavone promote hair growth in men and women. The participants took 6 mg a day of capsaicin and 75 mg a day of isoflavone orally for 5 months. That means eating a quarter of a fresh jalapeño pepper for capsaicin and three quarters of a cup of soybeans a day is beneficial for hair growth. [4]

Keep your gut bacteria happy

Studies show that if you insert stool from a donor into a person's colon who experiences alopecia areata, or spot baldness, significant hair regrowth occurs. That doesn't mean that you have to undergo a similar procedure. It just goes to show how a healthy gut plays an important role in autoimmune conditions, such as alopecia areata. Keeping your gut bacteria happy through a diet rich in fiber, vegetables and fruit, such as the Mediterranean diet, is beneficial, not only regarding hair loss. [5]

Work on improving sleep

Poor sleeping habits are associated with hair loss. It makes sense, since bad sleep causes stress and stress leads to a cascade of negative reactions in the body. There's obviously a difference between one bad night of sleep and insomnia, just as there is a difference between a short episode of stress or a single fight or flight reaction and chronic stress. [6]

Don't eat junk food

The same investigation of male pattern hair loss that looked at the association with poor sleeping habits also found a connection between junk food consumption and hair loss. [6]

Caffeine shampoo

Studies done with female and male participants show promising results in the use of caffeine applied topically. One study had one group of participants use a caffeine shampoo and the other group got a placebo. After six months, 84.8% of individuals in the caffeine group were satisfied with the results, compared to 36.4% in the placebo group. [7]

Microneedling

You can get a microneedling device or Dermaroller very cheaply and massage your scalp with it. It is supposed to increase blood flow and thus promote hair growth. But don't overdo it, otherwise it can cause to trauma to the skin and lead to scarring alopecia. Use a needle that is not longer than 0.5 mm and do it every other day for 5 to 10 minutes. [8]

Bryan Johnson's topical medication

Bryan Johnson, who has set out on a quest to live forever, published a video about how he reversed his hair loss. In that video, he mentions using a topical that he applies to his scalp daily. The ingredients are a customized mix that a local pharmacy makes for him. The compounds are:

Caffeine USP 1%

Finasteride USP 0.25%

Minoxidil USP 5%

Azelaic Acid 1.5%

Diclofenac 0.5%

Tea tree oil 5%

Rosemary oil 0.37%

Ginkgo biloba 0.05%

Biotin 0.01%

Melatonin USP 0.0033%

We'll discuss Finasteride and Minoxidil later in this article.

The other compounds have partly been shown to have promising results in treating hair loss. They work by increasing blood flow, decreasing inflammation, having anti-oxidative and anti-microbial effects, increasing the anagen growth phase and decreasing DHT. How well this exact topical formula works is hard to tell because we don't know whether these are the optimal doses for these compounds. It's also important to note that they address different causes of hair loss at the same time. Think of it as a shotgun approach, or taking a multi-vitamin. [9]

Red Light or Low-Level Laser Therapy

Red Light Therapy works by wearing a red light hat, helmet or a red light lamp. It is supposed to increase blood flow and thus stimulate hair growth. Research suggests that there is a statistical increase in hair density and hair thickness. On the other hand, studies that compared subjective satisfaction using a red light helmet and a placebo device could not find a significant difference.

Low-Level Laser Therapy works by stimulating cellular activity and blood circulation to the follicle. It appears to have a similar or better efficacy to the available drug interventions. They are relatively safe, with mild side effects ranging from itching to scalp tenderness. The research has been received with skepticism, since most of the trials were funded by the manufactures of the LLLT devices. In an independent study, blinded analysis of before and after images did not detect an improvement in hair density or caliber.

If you want to give it these interventions a try, limit yourself to three times a week for 10-30 minute sessions, otherwise you could harm your skin or cause a hypersensitivity reaction. You have to be consistent, and it may take 6 months to start working and if you stop, the benefits are lost. This treatment should be viewed as part of a stack of interventions, not as the single measure that will cure your hair loss. Do not look into the light, as that could damage your eyes. [10]

Hair pulling and hairstyles

Don't pull your hair too hard and don't get into a hair pulling fight. These are two obvious, common sense rules to live by. Certain hairstyles, like braids, can cause traction alopecia because they pull back your hair rigorously. So being mindful of your hairstyle while you still have hair can save you some in the process.

Things you should only consider with caution

These are things you can do that come with side effects. I personally do not recommend these, and I would not do them, but I'm not your doctor or anyone's doctor. So do your own research, speak to your doctor and make your own decision. The problem is that if you want your hair to stay, you'll have to use these medications forever. Don't take risk factors lightly, and be aware that you might have to deal with long-term consequences that are insufficiently studied.

Platelet-Rich Plasma (PRP) Injections

Platelet-rich plasma is created by clinicians taking a blood sample from a patient and placing it into a centrifuge that rapidly spins the sample. Other components of the blood are separated from the platelets and concentrate them within the plasma. The solution is then injected into a patient's scalp. It appears to have an efficacy that is comparable to Finasteride and Minoxidil, but the available evidence seems to be too insufficient to recommend it. [11]

Finasteride

Finasteride is an FDA approved medication that blocks the enzyme 5 alpha reductase and decreases DHT in the blood stream. DHT is a contributor to hair loss. Finasteride is effective in treating hair loss, but it can cause depression, low libido, and erectile dysfunction, among other things, even after you've stopped taking it.

Note that it is not FDA approved for women, because of teratogenic effects on male fetuses. [12]

Minoxidil

Minoxidil is also FDA approved. 5% Minoxidil like Rogaine is a foam that men and women can put on their scalp. It increases the anagen (growth) phase of the hair. It also increases blood circulation and oxygen delivery to the hair follicle.

Side effects include itching of the scalp, swellings or dizziness.

Dutasteride

Like Finasteride, Dutasteride has been shown to be quite effective in treating hair loss. It works similarly by blocking 5 alpha reductase. It should not be used by women because it can cause birth defects in male fetuses, and it comes with similar side effects like Finasteride. [13]

Hair transplants

This topic is so extensive that it would require a standalone article. Hair transplants do "work", but they take time. You go through a recovery process, during which the scabs from the surgery fall off after 10–14 days. What's left are the small shafts of hair that were placed into the skin. These shafts fall out 2-6 weeks post operation. It takes 3 months to see fresh growth of hair. Month after month you'll see improvement in hair growth. In total, it takes one to one and a half years to see the final result.

Two of my friends went to Turkey to get a hair transplant. It cost them a couple of thousand dollars, it was painful post operation, despite painkillers and one of my friends wasn't able to sleep for nearly two weeks, because he experienced increased nerve sensitivity. While this might be an exception and not the norm, it is wise to really think through whether you want to go this route or not.

The Ray Peat diet

Ray Peat was an expert in thyroid dysfunction. Danny Roddy popularized his diet in his book Hair Like a Fox. Peat suggested unconventional things like eating liver, eggs and sugar and drinking Coca-Cola, milk and orange juice. If hair is that important to you, I would suggest you try some of the other methods discussed earlier in this article. Because in the long run, these nutritional behaviors, even if done for bioenergetic reasons, are not healthy and cause other problems, as mentioned in "What to eat for longevity".

Myths and things you can just ignore

Myth: Botox can help with hair growth

It was thought that relaxing the scalp muscles would increase blood flow and thus increase hair growth, but researchers found out that Botox actually caused hair loss. [14]

Myth: Don't comb your hair too hard

You can pull your hair too hard, yes. Everyone has pulled out a hair or two at some point in their lives. But there's no need to worry that combing your hair might cause significant and systematic hair loss. It's more that these hairs might have fallen out eventually, anyway, which is completely natural.

Myth: Apply rice water to your hair

This is a recent trend on social media. You see young women apply rice water to their hair. There is no scientific evidence to confirm that this does anything but smell.

Myth: Castor oil for hair growth

Applying castor oil to your hair does not increase hair growth. It only makes your hair thicker when it soaks with castor oil and might trick you into believing that you've grown more hair.

Myth: Coconut oil for hair growth

Coconut oil applied to the hair will moisturize your hair. When the carotene in your hair breaks down, it can be held together by the coconut oil. So you could say coconut oil can help preserve hair. But it cannot stimulate hair growth. Be aware that it can start to smell unpleasantly.

Myth: Biotin supplements or hair products for hair growth

While Biotin is a compound that helps build carotene, which is important in the building of hair follicles, it is very rare that someone actually has a biotin deficiency. Eggs, lentils, nuts, seeds, sweet potatoes, mushrooms, bananas, broccoli and avocados all contain Biotin. So whether you eat a normal diet or eat plant-based, you should be good to go and don't need a Biotin supplement or shampoo with extra Biotin in it. [15]

Myth: Zinc or iron supplements for hair growth

Unless you have a real deficiency, you do not need zinc or iron supplements. While a supplement can help to get you to normal levels, you might as well eat foods high in zinc and iron, such as pumpkin seeds (which are beneficial for hair growth as we've discussed earlier), oats or peanuts. Having higher than optimal zinc levels, due to supplementation, can lead to zinc toxicity and create negative side effects, including copper and calcium deficiency. [16]

Myth: Ginger for hair growth

Ginger (Zingiber officinale) has been traditionally used in East Asia to treat hair loss and stimulate hair growth. There are shampoo companies claiming that the ginger extract in their products can stop hair loss and promote hair growth, but there's no scientific evidence to prove that. On the contrary, researchers actually found that ginger can suppress hair growth in humans. [17]

Read the second part of this series on hair loss: "How to make peace with going bald".

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