Dec. 7, 2022 -- You’ve likely seen the ads for nutritional supplements, gummies, shampoos, and other nonprescription products that allegedly help stop hair loss.
But do they work? The FDA does not regulate nutritional products, which means that manufacturers do not have to conduct or submit studies of safety and effectiveness to sell them. But a new review in a prestigious medical journal found that some of these companies have conducted trials, finding that some of the products are likely effective in helping to combat hair loss.
The authors of the review, published online in JAMA Dermatology in November, combed the medical literature to find data on a wide variety of ingredients and approaches used in over-the-counter hair loss remedies. They came up with thousands of articles, but only 30 met the criteria for objectively looking at their effectiveness.
The supplements that seemed to offer some potential benefit included the brands Lambdapil, Nourkrin, Nutrafol, Omni-Three, and Viviscal; capsaicin and isoflavone capsules; omega-3s and omega-6s with antioxidants; apple nutraceutical; the Chinese herbal extracts of total glucosides of paeony (Peony) and compound glycyrrhizin (licorice) tablets; zinc; tocotrienol; and pumpkin seed oil.
“For patients that are highly motivated and eager to try this, we’re hoping that this systematic review serves as a foundation to have a conversation,” with a dermatologist, says study co-author Arash Mostaghimi, MD, MPH, assistant professor of dermatology at Harvard Medical School.
Mostaghimi says he was surprised that he and his colleagues found evidence of effectiveness for the supplements but that he’s still skeptical that they work as consistently as described or as well as described, given that they were unable to find any negative studies. (The studies they did find also had many flaws, including small numbers of patients, studying different kinds of hair loss in the same trial, a lack of a control group, and self-reported perception of hair loss.)
They did not find any safety issues with any of the supplements, with the exception of biotin.
“The FDA has warned against biotin supplementation because it can interfere with some laboratory testing such as troponin and hormonal tests,” Mostaghimi and his co-authors write in the analysis.
Eva Simmons-O’Brien, MD, a dermatologist in Towson, MD, who often recommends supplements as an additional treatment to prescription products for hair loss, says she also cautions against biotin use. There are some misperceptions about what it can do, she says. For instance, it won’t grow new hair, but it can help strengthen the new hairs that grow as a result of other therapies.
The review is important because “it basically kind of vindicates what some of us have been doing for a number of years in terms of treating hair loss,” she says. “It should hopefully make it more commonplace for dermatologists to consider using nutritional supplements as an adjuvant to treating hair loss."
Lynne J. Goldberg, MD, professor of dermatology, pathology, and laboratory medicine at the Boston University Chobanian and Avedisian School of Medicine, says the review will be helpful because many patients take hair loss supplements and want to know if they are safe and effective.
The study “points out what the problems are, it talks about what the individual ingredients are and what they do, what the problems are, and it concluded that some people may find these helpful. Which is exactly what I tell my patients,” says Goldberg, who is also director of the Hair Clinic at Boston Medical Center.
The review begins with a look at saw palmetto (Serenoa repens), a botanical compound thought to block the action of 5-alpha reductase, which converts testosterone to dihydroxytestosterone (DHT). DHT is involved in male and female pattern hair loss (known as androgenic alopecia or AGA). The drug finasteride works in a similar way. Saw palmetto appears to stabilize hair loss, “although its effect is likely less than that of finasteride,” write the authors. They also note that side effects associated with finasteride, such as sexual dysfunction, were also observed with saw palmetto, “but to a lesser extent.”
Pumpkin seed oil, which also blocks 5-alpha reductase, may also be effective and an alternative to finasteride, they say.
Products containing extracts from sharks and mollusks, including Viviscal and Nourkrin, are thought to decrease hair loss by providing essential nutrients to thinning hair. Those supplements appeared effective in increasing hair counts in men and women, but studies were funded by the manufacturer and were not well controlled, said the study authors. Side effects with Viviscal also included bloating.
Multi-ingredient supplements such as Nutrafol and Lambdapil seemed to have some effectiveness, but each of the studies was flawed in some way, say Mostaghimi and his colleagues.
Hair loss is a complicated condition and ultimately requires multiple solutions, say dermatologists.
Simmons-O’Brien says that when evaluating patients with hair loss, she runs tests to determine if there is anemia or a thyroid issue or deficiencies in vitamins or minerals or other nutritional deficiencies, asks about diet and styling practices, and takes a scalp biopsy. She may recommend supplementation based on those findings, she says.
Goldberg says some of her patients prefer to steer clear of prescription medications. She might recommend supplements in those cases but tells patients that they aren’t well-studied and that it can be hard to tell if they are working, and in some cases, the hair loss might resolve in a few months anyway.
But, she adds, “if you have the money and you want to take these pills and you’re not taking too much, that’s fine.”
“As a hair loss specialist, my job is to treat the patient at their level, in their framework, in their comfort zone," says Goldberg.
Mostaghimi says he understands why people turn to supplements.
“I believe if we had better and more effective treatments for hair loss of all types, then people wouldn’t be using these supplements or going to more natural therapeutics,” he says.