Hair Loss &
Thinning Hair

What We’d Skip

Hair loss is distressing, and a lot is sold to people at exactly that moment.

1. Don’t take biotin unless you are deficient

   A true biotin deficiency is rare and comes with other signs. Extra biotin does not help hair without one, and it can throw off thyroid blood tests, which can lead to medication you do not need.

2. Don’t count on rosemary oil

   Of rosemary oil, Dr. Idriss says it “is not going to help you.” See a dermatologist instead, so the cause is found and treated.

3. Don’t quit minoxidil in the first weeks

   An early shed is expected while hair moves into its growth phase, usually between weeks two and six. Give it at least three months, and tell your doctor if shedding lasts beyond four. Stop it, and you go back to where you were.

4. Don’t microneedle your scalp hard at home

   Rolling hard at home can break the hair you are trying to keep. In the office, PRP is injected into the scalp rather than microneedled, for the same reason.

5. Don’t start a hair loss pill without a doctor

   Oral minoxidil is not for anyone with heart disease or blood pressure problems, and finasteride, as a pill or on the scalp, is avoided by women who are or could become pregnant. Your doctor checks first.

How Is Hair Loss Treated?

Treatment follows the cause, so it starts with a diagnosis. Pattern hair loss has no cure, and Dr. Idriss’s advice is to “throw the kitchen sink” at it, starting several treatments at once and paring back to what works.

1. Any new hair loss or shedding. Find the cause first. Your doctor looks at the pattern and often orders blood tests, such as a thyroid panel and iron levels. If a medical cause is found, treating it comes first.
2. Female or male pattern thinning. Daily medical treatment is the foundation. That means minoxidil, on the scalp or as a prescription pill, and prescription topical finasteride. They keep working between visits, for as long as you use them.
3. Thinning that continues, or to add a boost. PRP for Hair Loss, made from your own blood, is added to the plan as three treatments a month apart, judged five to six months after the first. Not everyone responds.

A hair transplant does not replace these treatments. It can be worth adding where hair has thinned past what treatment can bring back, and even after a transplant we usually recommend a combination of the treatments above to maintain the result. A transplant is not a cure: as long as hair loss continues, the hair around the transplant keeps thinning. Your doctor will tell you if a transplant surgeon’s opinion should also be considered.

Hair Topicals & Supplements:
What Actually Helps?

Medical treatment is the daily part of a hair plan, and PRP adds to it, never replaces it. None of these is a cure, and each one works only for as long as you use it.

• Topical minoxidil

  The ingredient in Rogaine, sold over the counter as a foam or liquid. It is believed to widen blood vessels in the scalp and keep hair in its growth phase longer, so the hair you have stays longer and looks fuller. Expect an early shed, then three to six months of consistent use before you judge it. Keep it off your face, and away from cats and dogs, because it is toxic to them.

• Oral minoxidil

  A prescription pill, used off label at a low dose. Dr. Idriss switched to it when the topical irritated her scalp, and calls it “the thing that made the biggest difference” for her hair. It is not for everyone. Your doctor checks your heart and blood pressure first, and it can grow hair elsewhere on the body.

• Topical finasteride

  A prescription that blocks DHT, the hormone that shrinks hair follicles in pattern hair loss, compounded for the scalp and often mixed with minoxidil. Dr. Idriss prefers it to the pill, whose side effects include lower libido; less reaches the body, but the topical is not free of side effects. Women can use it if they are past menopause or using reliable contraception.

• Spironolactone, for some women

  A prescription that lowers the effect of androgens, used off label for some women with hormonal hair loss, especially with PCOS. It is not taken by anyone trying to become pregnant.

• A medicated shampoo

  Ketoconazole shampoo, an antifungal for dandruff, also blocks DHT a little. It is weaker than finasteride, but Dr. Idriss uses it herself, and it may help slow hair loss.

• Supplements, for what you lack

  Low iron and low vitamin D are common, treatable findings in women losing hair, which is why blood tests come first. Skip biotin unless you are deficient. Dr. Idriss takes a biotin free hair supplement and has used prenatal vitamins.

In Their Words