If you want to make a lot of money, all you have to do is come up with an effective treatment for androgenic alopecia. That’s male pattern baldness. Actually, even a minimally effective product will do. Or one that has no efficacy at all, like a shampoo that claims to “unclog the scalp by cleaning follicles,” or a brush that “stimulates hair growth.” That’s because hair loss is so distressing, and so damaging to self-esteem, that many men are willing to plunk down money for anything that hints at regrowth, be it a drug, some “natural” concoction, or a cap that delivers “low level laser light therapy" (LLLT).
There is no single cause for hair loss. Genetics, nutritional deficiencies, hormonal changes, certain medical conditions and stress all play possible roles. The best studied influencer has been dihydrotestosterone (DHT), a hormone that causes hair follicles, the shafts in the skin from which hair grows, to shrink. This results in thinner hairs and eventually no hairs being produced. Since dihydrotestosterone forms from testosterone through the activity of the enzyme alpha-reductase, inhibiting this enzyme can prevent hair loss. Finasteride (Propecia) is an oral medication that interferes with the activity of this enzyme and leads to modest regrowth. It certainly cannot be used by women of child bearing age because finasteride can cause fetal abnormalities and it hasn’t been studied in post-menopausal women.
The cells that make up the hair follicle need the appropriate raw materials, namely amino acids, vitamins and minerals, to produce keratin, the protein that is the basic component of hair. These are delivered through the bloodstream so that any increased circulation through the scalp benefits hair growth. Minoxidil (Rogaine) is a topical medication that widens blood vessels and increases nutrient and oxygen delivery. This causes follicles that are in the telogen phase, the resting phase of the hair growth cycle, to revert to anagen, the active growing phase. Minoxidil can be used by men or women and is most effective at the first sign of hair loss. In rare cases, hair loss is due to a nutrient deficient diet, particularly one that lacks biotin, a B vitamin. In this case a biotin supplement can help.
A number of “natural” oral supplements have also appeared on the market with Nutrafol, Viviscal and Replenology being widely promoted. Each one of these contains a plethora of ingredients that are said to have been selected based on scientific evidence for supporting hair growth. Since these supplements are regulated as “natural health products,” there is no requirement to provide any evidence of efficacy.
Reprenology, for example, is a system that combines an oral supplement, a shampoo, a conditioner and a “follicle serum.” The capsule alone contains 28 ingredients! What are they? Vitamins, minerals and a host of plant extracts in unknown amounts. I don’t know what Malus domestica, which is the common apple, has to do with hair growth, but Moringa oleifera, the “drumstick tree,” has some anti-alpha reductase activity. Eclipta prostrata, also known as “false daisy,” can supposedly stimulate anagen. These ingredients are also present in the “follicle serum,” although instead of Malus domestica, we have Pyrus malus, which is crabapple. I’m not just being crabby when I say there is no evidence for this, but there isn’t any. Caffeine is also included for some unknown reason.
Curiously, Reprenology contains no saw palmetto which is known to be an alpha reductase inhibitor. However, it is present in Nutrafol, which has a different grab bag of ingredients that include curcumin, ashwagandha and hydrolyzed marine collagen along with an array of vitamins and minerals. Then there is Viviscal, which for some reason specifically targets women with its “proprietary blend of shark and mullusk powder, organic silica, microcrystalline cellulose, magnesium citrate, hypromellose and glycerol.
Putting aside the questionable science behind assembling the cacophony of ingredients found in these natural products, the question we are interested in is whether the products can actually grow hair. Well, they can. Just not very much of it in most cases. There actually are some double-blind clinical trials that definitely document growth, but the problem is that the documentation is generally expressed in terms of hairs per square centimeter. It is difficult to know how that translates to a practical effect. An increase of 20 hairs per square centimeter may be statistically significant, but does it mean that an observer will take notice? Without proper statistics of user satisfaction backed up by photos, we just don’t know. Results with all these hair growth products seem to be very variable, so the only way to find out if one works is to open your wallet and give it a try. And get ready to open that wallet quite wide. Although not as wide as for a cap that targets the scalp with red light emitted at a wavelength of 655 nanometers that supposedly increases circulation in the scalp. Here we are talking over a thousand dollars for a hat that has to be worn for about half an hour a day for months. Again, there is evidence for some growth, but to variable extents. However, if you really want to be noticed as sporting new hair, transplants have improved significantly. And of course, there are wigs. They unquestionably work.
