Half of men experience some degree of hair loss by the time they turn 50 and 40% of women are affected by age 70. “Pattern” hair loss is the most common cause of hair loss in both men and women.

Two medications are available to treat pattern hair loss: minoxidil (Rogaine) for men and women and finasteride (Propecia) for men. Unfortunately, neither of these medications is very effective, and both have side effects.

A number of integrative interventions including solubilized keratin, essential fatty acids, and saw palmetto extract may prevent hair loss and promote healthy hair growth.

Causes

• Hereditary and genetic factors: Influences age of onset, rate, and degree of hair loss
• Hormonal: Includes pregnancy, menopause, and hormonal disorders such as polycystic ovary syndrome and thyroid abnormalities
• Medical: Includes autoimmune diseases, skin conditions, and severe physical or emotional trauma
• Drug-induced: Includes chemotherapy and radiation therapy, beta-blockers, and oral contraceptives
• Nutritional: Severe protein and essential fatty acid deficiencies; overall malnutrition and crash diets; and iron, zinc, biotin, and vitamin D deficiencies

Treatment

• Finasteride, an oral medication approved for men, is a 5α-reductase inhibitor that suppresses the conversion of testosterone to dihydrotestosterone (DHT), which contributes to male pattern hair loss.
• Topical minoxidil is a vasodilator approved in both 2% and 5% formulations for treatment of pattern hair loss in men and women.
• Surgical hair restoration in the form of hair transplantation is widely used to treat pattern hair loss in men and women.
• Scalp cooling is an effective method of preventing hair loss induced by chemotherapy, reducing the risk by 62%.

Novel and Emerging Strategies

• While dutasteride, a medication like finasteride, has not been FDA approved as a treatment for hair loss, evidence indicates it effectively improves scalp hair growth, possibly even more than finasteride.
• Topical estrogens are available in Europe for use in hair disorders. In a trial in 53 women with female pattern hair loss, volunteers applied a topical 0.025% 17α-estradiol solution to their scalps daily for eight months. The treatment led to improvements in hair density, and was well tolerated during the study period.
• Early research indicates topical caffeine may exert positive effects on hair growth, including a stimulatory effect on hair follicles.

Integrative Interventions

• Solubilized keratin: In a placebo-controlled study in women with stressed or damaged hair, there was less hair loss, improved hair strength, and better hair appearance in the group taking Cynatine, a novel form of solubilized keratin.
• Essential fatty acids: A trial in women with early-stage hair loss found daily supplementation with fish oil, black currant seed oil (providing gamma-linolenic acid), lycopene, and vitamins C and E led to improved hair density compared with a control group.
• Silicon: In a study of women with fine hair who received orthosilicic acid (which provides silicon) or placebo for nine months, hair strength and elasticity were better preserved and hair thickness increased in the supplemented group.
• Saw palmetto: In a two-year trial comparing the effects of oral saw palmetto extract to finasteride in 100 men with mild-to-moderate pattern balding, finasteride led to hair regrowth in 68% of subjects, while 38% of those in the saw palmetto group experienced improved hair growth.
• Tocotrienols: In a study involving 38 women and men with various types and degrees of hair loss, those receiving supplements with alpha-tocopherol plus mixed tocotrienols experienced a more than 34% increase in hair numbers over eight months, while those receiving placebo experienced a slight decrease in hair numbers.