Tuesday, February 7, 2017

Scientifically tested, over-the-counter treatments for thinning hair

Please remember that this information can and should never replace the care and advice of a physician. If you experience hair thinning, seek consultation with a medical professional who listens and will physically examine your scalp. 

Be aware that scalps can be sensitive to any and all treatments and products, including natural ones. Scalps that are losing hair may be more sensitive than scalps in which hair density is stable.

This post has lots of links. Where I can link you to a full article, I did. Otherwise, I linked to abstracts, which contain a summary of the study's contents.

Androgenic alopecia is the clinical term of male and female pattern hair loss. It’s one of those diagnoses of exclusion. If you don’t have telogen effluvium (hair loss following an exposure to an allergen, due to physical or mental trauma), or alopecia areata (patches of hair loss), traction alopecia due to tension on your scalp, or hair loss due to thyroid disease, scalp disease or polycystic ovarian syndrome - then you likely have androgenic alopecia.©Science-y Hair Blog 2017

If you start to experience hair loss that is more than you are accustomed to, it’s ideal to have a doctor or dermatologist check for other causes of hair loss before concluding you have androgenic alopecia. Hair loss can be a sign that something else is wrong.

Female pattern hair loss and male pattern hair loss take on different patterns, which you can find men's here and women's  here. ©Science-y Hair Blog 2017

Androgens are hormones which are more abundant in men than women, specifically testosterone. Testosterone circulates in your blood and in the hair follicle, can be transformed into dihydrotestosterone (DHT) by the enzyme alpha-5 reductase in your hair follicles. This is thought to be damaging to hair follicles. The end result is that hair follicles begin to produce narrow, “vellus” hairs. Like the hairs on non-hairy parts of your body, they are very thin, narrow and difficult to see. As these replace normal-width hairs on your head, overall hair thickness decreases. 

Note that the "DHT-causes-hair-thinning" idea is not unequivocally proven. There are other variables at work on scalps with thinning hair like low-grade inflammation and atopy (allergy to airborne allergens, contact allergens, yeasts in normal scalp flora).©Science-y Hair Blog 2017

There are some proven treatments for Androgenic alopecia which work in a variety of ways. These are ones you can buy over the counter, they don't require a prescription. Some of them you can use together. If in doubt, ask a pharmacist, doctor or dermatologist.

1) Minoxidil.  For example: Rogaine. ©Science-y Hair Blog 2017

2) Topical caffeine. ©Science-y Hair Blog 2017
Yes, it has to go on your scalp, drinking caffeinated beverages doesn’t count. 

  • Caffeine is a quickly-absorbed vasodilator to increase blood flow in the scalp. Caffeine does not need to stay on the scalp until the next washing (that's why shampoos work), but it does need about 2 minutes to absorb into your skin before rinsing
  • In men especially, topical caffeine may decrease trans-epidermal water loss, which means skin stays hydrated
  • The concentration used in the studies linked here is 0.001% to 0.005% - very low for an active ingredient. 
  • Topical caffeine affects the whole body and too much on your skin is the same as too much when ingested. Larger concentrations can be dangerous. If you're caffeine-sensitive, yes - this might keep you awake if you use caffeine in products at night.
  • In lab tests on skin in culture which was treated with testosterone, hair growth was suppressed. When topical caffeine was added, it stimulated hair growth back to normal, so there may be an element of DHT and alpha-5 reductase
  • Caffeine stimulates hair growth and helps hair stay in anagen phase longer - the growing phase - than it otherwise might in people with androgenic alopecia. 
  • Caffeine can slow down excessive shedding and stimulate hair growth. 
  • Topical caffeine has been measured to stay active in hair follicles for up to 48 hours, so it needs to be used every 1-2 days to be most effective.©Science-y Hair Blog 2017

There are a number of products - shampoos, sprays, serums you can purchase which already contain caffeine. Some contain additional ingredients which may be beneficial. There is a do-it-yourself recipe following this list.

Caffeine-Containing Hair Products
  • Alpecin Caffeine shampoo (with ketoconazole)
  • Alpecin After Shampoo Liquid
  • Amplixin Intensive Hair Growth Serum
  • Dove Men + Care Fortifying 2 In 1 Shampoo, Complete 2-in-1 shampoo
  • Art Naturals Organic Argan Oil Hair Loss Shampoo
  • GrowMe Shampoo, Sulfate Free - Watermans  UK brand 
  • ConditionMe Hair Growth Conditioner - Watermans UK brand 
  • Hair Lab Hair Growth Serum
  • Hair Lab Regrowth & Thickening Shampoo
  • Man Cave Caffeine Shampoo  
  • OGX Fight Fallout Niacin & Caffeine Plus Shampoo 
  • OGX Fight Fallout Niacin & Caffeine Conditioner 
  • OGX Fight Fallout Root Stimulator
  • Pura D'Or Anti Hair Loss Argan Oil Shampoo (with pyrithione zinc) 
  • Revita Hair Stimulating Shampoo (with ketoconazole) (Sulfate free) (Not for vegetarians)
  • SebaMed Scalp Activating Shampoo for Thinning Hair
  • Thicker Fuller Hair Shampoo 
  • Thicker Fuller Hair Weightless Conditioner
  • Thicker Fuller Hair Instantly Thick Serum (this is a styling product, not a scalp product)
  • Ultrax Hair Surge Caffeine Hair Growth Stimulating Shampoo
  • Ultrax Hair Solace Conditioner
  • Ultrax Labs Hair Lush Thickening treatment serum
  • Wick and Strom Anti Hair Loss Shampoo (with ketoconazole)

DIY recipe: Mix the contents of one, 200 mg capsule of caffeine powder (such as this one with no fillers or additives) with 1 gallon (about 4 liters) distilled water. Use as a spray or put in a dropper bottle. Using too much can cause the same side effects as ingesting too much caffeine, or can cause scalp irritation. ©Science-y Hair Blog 2017
  • The end concentration is 0.005% with this mixture.
  • This recipe is cheap and it really works! I was experiencing extra hair loss and using this on my scalp every other day has reduced my shedding by about 60%.

Can brewed tea or coffee be used? Yes! But not decaffeinated tea or coffee. Tea and coffee can create cool tones in hair. The tea or coffee needs to contact your scalp and be left on for at least 2 minutes.

3) Ketoconazole shampoo
Ketoconazole is an anti-fungal medication that can help reduce hair loss - it’s sold for managing seborrheic dermatitis - dandruff. Higher concentrations are found in Nizoral shampoo, and Regenepure DR in the US. There are some shampoos with both caffeine and ketoconazole in the list above (Alpecin Caffeine shampoo, Revita Hair Stimulating Shampoo, Wick and Strom Anti Hair Loss Shampoo). Ketoconazole may help by ultimately reducing inflammation, or by interfering with the alpha-5 reductase enzyme. ©Science-y Hair Blog 2017
  • Ketoconazole shampoos are used every 2-3 days in studies that showed decreased hair loss by about 17%, a greater number of hairs in anagen phase (growing phase), greater hair density and width (compared to narrowing hairs with androgenic alopecia).
  • It may be especially helpful for thinning hair if you have ever had seborrheic dermatitis, eczema, rosacea, or itchy scalp or any sort of scalp flaking, including little powdery dry flakes.
  • Results are similar to 2% Minoxidil - which is response in approximately 40% to 50% of people using it.

4) Pyrithione zinc shampoo
This is another dandruff shampoo that can decrease inflammation in the scalp and slow hair shedding (by about 10%). It may or may not encourage more normal-width hairs to grow, depending on the study.  
It may be more helpful if you’ve ever had seborrheic dermatitis, eczema, rosacea, or itchy scalp.
Use a pyrithione zinc shampoo every 2-3 days.

5) Pumpkin seed oil (eating pumpkin seeds or supplemental oil, not topical, though it's a great oil in conditioners)
Pumpkin seed oil supplements in one, 6-month study which was double-blinded and placebo-controlled (the gold standard for studies such as this) had a positive effect on hair re-growth in men with mild to moderate androgenic alopecia. That translates into 40% increases in hair counts in men treated with pumpkin seed oil after 24 weeks versus only 10% increases in hair counts for men in the placebo group.
  • In animal studies, pumpkin seed oil alone has been demonstrated to block the action of alpha-5 reductase.
  • The dose was 400 mg of pumpkin seed oil in 4 capsules, 2 were taken with a morning meal and 2 with the evening meal, though the product used was not exclusively pumpkin seed oil. 
  • The specific supplement used in this study was “Octo-Sabal Plus” which is not available in the U.S., containing : Octacosanol, Pumpkin seed powder, Mixed vegetable powder, Evening prim rose powder, Corn silk extracted powder, Red clover powder, Tomato powder
  • Pumpkin seed oil may also support nitric oxide formation, an effect which may be supportive of healthy skin barrier function.
  • A tablespoon or about 15 ml of pumpkin seeds contains about 5 grams of fat (oils), which is 5000 mg - more than used in this study. If you regularly eat pumpkin seeds - it may be having a similar effect. And you get other nutrients too!

6) Protective foods and nutrients: One study of men with moderate to severe androgenic alopecia (including more of the scalp) found that regular consumption of soy beverages and higher vanadium intake appeared to be protective of hair thinning. Bear in mind, this was done by screening blood samples and having people fill out questionnaires about their eating habits. It is a study done in Taiwan, of men only, where dietary habits and favorite foods are different than in the U.S., where I am writing this.
  • Having an adequate intake of vanadium, which is especially high in shellfish, mushrooms, parsley and dill, is correlated with a lower likelihood of having moderate to severe androgenic alopecia, mild androgenic alopecia is still possible.
  • Regular consumption of soy drinks (1-3 days per week or more) correlates with a lower likelihood of having moderate to severe androgenic alopecia, mild androgenic alopecia is still possible.

7) Protective behaviors: Sleep
 Sleeping for fewer than 6 hours each night is correlated with more widespread hair thinning in men with androgenic alopecia (in the reference linked in #6). I know, you don’t need to hear that, all you busy people and night owls. 

8) Nigella sativa oil (topical), aka black cumin seed oil for telogen effluvium.
One double-blinded, placebo controlled study (pdf link) showed this oil, diluted and applied topically, can be helpful in re-growth of hair after telogen effluvium, which is significant hair loss following childbirth, serious illness, major surgery, exposure to severe allergens or irritants, severe emotional stress, significant weight loss. Acute telogen effluvium can persist up to 6 months after the initial provocation, but it lasts typically 3-6 months. Chronic telogen effluvium lasts longer than 6 months and can last for years. It is spread over the whole scalp, not in a pattern like androgenic alopecia although one may have thinning at both temples.
  • The “recipe” used in the study is 0.5% Nigella sativa oil, 3% glycerin, 0.4% lavender oil, and 60% alcohol, adding water to make up the balance of 100%. You should not put Nigella sativa oil on your scalp undiluted.
  • This was applied daily to the scalp for 6 months.
  • At 3 months, 9 of 10 patients receiving this treatment had increased hair counts, and half continued to have increased hair counts at 6 months.
  • Placebo-treated patients had improvement in 6 of 10 at 3 months and 6 months showed hair loss rather than increase.
  • Can you create this formula at home? Yes. You need a scale. This would usually be formulated with ethanol as the alcohol. the “60%” is a volume or weight, not a percentage alcohol or “proof.”
  • So if you were making 100g of this, you’d use 0.5g Nigella sativa oil, 0.4 g lavendar oil, 3 g glycerin, 60 g ethanol and just under 40g water.
  • There are some blackseed oil shampoos available as an easier way to use the oil, but they have not been studied in the same way.
9) Melatonin (topical)
One study of topical melatonin in androgenic alopecia found that both men and women, treated with a 0.0033% melatonin solution (with other ingredients) experiences a reduction in hair loss of up to 60%. Seborrheic dermatitis was also improved, when it was present. Melatonin may work through an anti-oxidant effect on a scalp experiencing oxidative stress. ©Science-y Hair Blog 2017
  • Melatonin is not soluble in water, you cannot crush the tablets or mix a capsule in water to make a DIY treatment.
  • Products for the scalp containing melatonin include Asatex
  • One "Full dropper" of this liquid melatonin product in 100 grams water will equal approximately the concentration used in the study linked above.
  • Melatonin products are applied to the scalp daily or taking 1 or 2 days off per week.
  • Because we have melatonin receptors in our skin, you may experience some sensations of sleepiness or dizziness after applying such a product, just like melatonin supplements. Use with caution! ©Science-y Hair Blog 2017


  1. Brilliant! I love your blog I learn a lot with your posts since my hair is not my best asset... haha
    Please, don't stop posting! <3 :D lots of love!

  2. Thanks for doing the research to find these treatments! In #8 using the black cumin oil, is it an essential oil? Is the lavender also an essential oil? I'd like to give this a try. What kind of ethanol can be used in this?

    1. Hello Lily,
      The black cumin seed is an essential oil, but it also is used as a supplement, so it comes in larger bottles. The lavender is an essential oil too, but it was used in the placebo and did not have an effect in hair growth. It probably improves the scent, but 0.5% black cumin seed oil doesn't smell very cumin-y for too long.
      There are shampoos which contain black cumin seed oil which might be easier.
      The ethanol is probably 200 proof, or that would be my guess, things found in labs. For home-creation, I would use the highest proof ethanol you can get. Vodka comes to mind.

    2. Thank you!! Which of these might be the most helpful for hair loss associated with a lupus flare? I currently follow the curly girl method...cowashing and using products without sulfate or silicones.

    3. Hello Kimberly,
      Discuss any of this with a doctor or pharmacist first! You don't want to have an interaction with any medication you are taking. All of these treatments have potentially systemic effects. I think you might lean towards the anti-inflammatory like blackseed oil, which was helpful in telogen effluvium. There are some blackseed oil shampoos available - the total amount of the oil is low, so it will be listed near the end of the ingredient list. If you click the pdf link, there are photos showing the scalps of some participants before and after - and that "redness under the skin" of inflammation is gone.
      Of course, getting enough sleep is ideal and making sure your Vitamin D and ferritin levels are in good shape is helpful. If blackseed oil didn't irritate your skin - you could add it to a co-wash. It might smell - odd.
      Best wishes! W

  3. Thanks, Wendy! I was thinking Vodka, too, as an easily obtainable source. I'll let you know if I start this and my results. My biggest issue is not wanting to wash my hair every day or even every other day, as most treatments require a certain frequency for results - thus my preference for oral supplements, but this seem worth a try.

  4. Thank you so much for this. Keep up the good work! :)