Hair shedding can be stressful, especially because it's hard to know when you're losing more hair than is average or normal. Gary Goldenberg, a board-certified dermatologist at Goldenberg Dermatology in New York City says that losing as many as 100 strands a day is standard. But when you start noticing significant hair loss in the shower, on your pillow, or your brush, it's time to visit a dermatologist for evaluation. Dermatologist recommended hair growth treatments could be the answer for you, so we spoke with four doctors to bring you the best options.
Meet the Expert
Gary Goldenberg is a board-certified dermatologist at Goldenberg Dermatology in New York City.
Michele Green, MD is a New York City based board-certified cosmetic dermatologist.
Craig Ziering, MD is the founder of Ziering Medical.
Gretchen Friese is a BosleyMD Certified Trichologist.
What Causes Hair Loss?
"The most common cause for hair thinning and hair loss is genetics," says Goldenberg. "The genetic male or female pattern (also known as androgenic) hair loss is extremely common and can start to manifest as early as in the 20s." Medical conditions, hormonal issues, and the natural process of aging can also cause hair thinning and loss.
Try a PRP Treatment
Goldenberg explains that PRP (platelet-rich plasma) treatments "harvest the power of your own body to help hair grow and support hair health." During the procedure, blood is drawn and the PRP from the blood is injected into the area of the scalp with hair loss or thinning. Goldenberg notes that PRP does several things to improve hair loss. For one, it "contains growth factors that provide support for hair that's already present and for the hair follicles that are dormant and stimulates them to grow," says Goldenberg. "It also contains vascular growth factors. These increase circulation to the scalp providing hair with more nutrition and oxygen needed for growth."
"Because PRP contains a range of growth factors and proteins that speed up tissue repair, doctors will often use this therapy when hair loss is a result of androgenetic alopecia (pattern baldness), which causes hair follicles to shrink," adds Friese. PRP can be used as a stand-alone treatment or be combined with other hair loss treatments to help create lasting, healthy hair. For example, minoxidil can be used to complement PRP hair treatments and can be used long-term to sustain the results achieved from PRP, Green says.
Possibly the most famous hair loss treatment, Rogaine is successful at preventing hair loss and promoting new growth. "Rogaine is a topical solution or foam that blocks the type of testosterone that causes hair miniaturization—the process that causes androgenetic hair loss," says Goldenberg, who recommends it for women just once daily. Its active ingredient, minoxidil, is an FDA-approved topical treatment for male and female pattern hair loss, says Ziering. He also notes that it is available over-the-counter and does not require a prescription. Minoxidil comes both as a solution and foam base, which needs to be applied to the scalp at bedtime, explains Green.
Minoxidil is effective at treating certain types of alopecia, as research has found that minoxidil prevents the conversion of testosterone into dihydrotestosterone (DHT). DHT has been linked explicitly to hair loss in multiple studies, making the prevention of its creation paramount to preventing hair loss and generating new hair growth.
Vitamin B Complex Injections
Goldenberg explains that vitamin B complex injections can help to promote healthy hair. "Many cannot absorb vitamin B from their diet, so injections of vitamin B complex may be the best way to receive this vitamin," he notes. "Some patients with normal vitamin B levels can still benefit from these injections when it comes to hair loss and hair support."
Clinical trials suggest that certain supplements and vitamins—vitamins D and E, as well protein-rich collagen and plant-based compounds—can be effective in promoting hair growth, notes Ziering. Vitamin supplements Viviscal and Nutrafol have also been shown to support a healthy mane, adds Green. And according to Goldenberg. "Biotin, zinc, and copper supplementation can help to improve hair quality and growth."
"Thermadome is a light device that one wears at least twice weekly for at least 20 minutes," says Goldenberg, who notes that some even wear it daily because you can't overdo it. "It stimulates hair to grow by shuttling nutrition and oxygen to the scalp."
"Low-level laser light has been used to regrow bone and tissue for years and the technology is now used for the stimulation of hair follicles and promotion of hair growth," Friese continues, "Thermadome is a kind of helmet or cap containing laser lights that aid in regrowing hair. The laser light targets the stem cells at the base of hair follicles, allowing the formation of a new photonic pathway that can restore hair to a healthy state."
The Lasercap is a prescription at-home FDA-approved device, which Green explains uses low light therapy to stimulate hair follicles. "The device is worn for 30 minutes, three times per week. I often recommend this device in combination with PRP treatments. The Lasercap is worn at home and is an excellent complement to any hair loss treatment," shares Green.
Laser therapies are still being studied to understand their impact on hair growth, but research suggests that improved cellular activity, reduced inflammation, and improved microcirculation may be involved. Ziering shares that the theory of laser treatment for hair loss is that the low-dose laser treatments invigorate circulation and stimulation that encourages hair follicles to grow hair. "Because the results of laser therapy are inconsistent, the conclusion of the medical community seems to be that it appears to work for some people, but not for others," says Ziering.
Proper Scalp Cleansing
It is important to keep your hair clean to encourage healthy growth. "Shampooing often is very important," says Friese, "Cleansing the hair follicles and keeping them free of oils, hair product build-up and free radicals will help create a healthy scalp environment for the hair to grow.
Scalp massage is another way to encourage hair growth, as it helps increase blood flow and circulation to the follicles making them stronger and discouraging miniaturization." You could use a scalp massager or simply your fingers, and do double duty by taking extra time to massage your scalp while you shampoo.
A Well-Balanced Diet
Not getting the nutrients you need can lead to hair loss. "Poor nutrition can cause malabsorption as well as inflammation in the body, which can disrupt the growth cycle of the hair. Inflammation does not allow the cells to repair completely which results in a weakening of the cells. When this reparative process does not occur, it causes cell damage which results in hair loss," cautions Green.
Creating a better microbiome could help your hair return. Friese tells us that "we are discovering more about the importance of a healthy gut and how it affects hair growth. Foods high in proteins and healthy fats are key to a good diet. Staying away from processed foods and those high in sugar are also very important. I often recommend adding eggs (high in biotin that encourages hair growth), avocados, and nuts, which are easy and convenient options for attaining healthy fats," she adds.
Keep in mind, that stress can also be a leading factor in hair loss. Working to create a low-stress lifestyle can be a powerful tool in promoting hair growth. Practice yoga, meditate, or enjoy a relaxing bath. Hydration levels also have a major impact on overall health and wellness, drink plenty of water.
Hair Transplantation or Hair Replacement Surgery
Depending on the severity and cause of your hair loss, your doctor may suggest a more permanent solution like hair transplantation or replacement surgery. Ziering explains that hair replacement surgery is a cosmetic procedure and includes such replacement procedures as micro-grafting, slit grafting, punch grafting, and scalp reduction. Some examples of these treatments are:
- Follicular Unit Excision and Extraction (FUE) is a surgical hair harvesting method used to obtain donor hair one graft at a time.
- Microscopically Dissected Elliptical Excision (MDEE) (formally known as FUT) is a surgical hair restoration procedure in which hair is harvested from the donor zone on the back and sides of the head where your hair is genetically programmed as permanent hair, and then it is transplanted into the balding or thinning areas of your scalp.
Spironolactone is an FDA-approved drug prescription medication that treats androgenetic alopecia in women by slowing down the production of male sex hormones (androgens), says Green. "Spironolactone is for females with hair loss due to hormonal imbalance it works by obstructing the androgen (male hormone receptors), which control the dihydrotestosterone (DHT) and testosterone levels, which can lead to different degrees of hair thinning or permanent hair loss," she explains.
What causes hair loss?
According to Ziering, hair loss can be the result of heredity or a normal part of aging. "Some other causes for hair loss that we don't often think about are vitamin deficiencies, new medications, recent surgeries, stress, weight loss, and hormonal changes," adds Goldenberg. "Telogen effluvium is the second most common type of hair loss we see in our practice. It's usually related to a stressful event, pregnancy, or illness." Luckily, this type of hair loss is usually temporary, he says, but it can uncover a more chronic hair loss issue.
When should I consult a doctor about my hair loss?
If you are beginning to notice your hair shedding or thinning you should consult your doctor immediately. It is very important to have a board-certified dermatologist examine you and diagnose the cause of hair your loss. "Getting treatment quickly will minimize the overall impact of your hair loss and give you a better chance of growing back your hair," says Green.
How much hair loss is too much hair loss?
Ziering offers the following advice: "Most hair shedding is due to the normal hair cycle, and losing 50-to-100 hairs per day is no cause for alarm." However, anything more than this, you should consult your doctor.
Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777-2786.
van Zuuren EJ, Fedorowicz Z, Schoones J. Interventions for female pattern hair loss. Cochrane Database Syst Rev. 2016;2016(5):CD007628.
Wall D, Meah N, Fagan N, York K, Sinclair R. Advances in hair growth. Fac Rev. 2022;11:1.