Treatment for hair loss: what really works?

First: hair loss does not necessarily mean permanent alopecia

Our hair has a biological cycle.

Each follicle goes through a growth phase, a transition phase, and a resting phase before the hair finally falls out.

That is why we all lose hair every day.

What matters is distinguishing physiological renewal from abnormal hair loss and, above all, determining what is happening at the follicle level.

A person may experience abundant, temporary hair loss after an illness and subsequently recover their hair.

Another person may notice little hair shedding, yet be slowly developing androgenetic alopecia in which each new generation of hairs is progressively finer.

At first glance, both people might say: 'My hair is falling out.'

Medically, however, they may need completely different approaches.

So, what is the best treatment for hair loss?

The one that addresses the cause.

There is no single treatment that works for all types of alopecia. Even two patients with an apparently similar diagnosis may need different strategies.

Let us look at some examples.

If we have androgenetic alopecia

Androgenetic alopecia is one of the most common causes of progressive loss of hair density.

It can affect both men and women.

In this case, genetically predisposed follicles progressively undergo a miniaturization process: hairs become thinner and shorter.

In this case, we do have treatments capable of slowing the process and, in certain patients, improving density.

Minoxidil

Minoxidil is one of the treatments with the most experience in androgenetic alopecia.

It can be used topically and, in certain selected patients, doctors also use oral minoxidil at low doses.

But as we explain in our specific article on minoxidil: minoxidil does not mean a universal treatment for all hair loss.

Its usefulness depends on the diagnosis.

For androgenetic alopecia, clinical guidelines particularly support topical minoxidil, and the response must be assessed over months, not just a few weeks.

What about finasteride or dutasteride?

These are medications that act on androgen metabolism and may be part of the treatment for certain patients with androgenetic alopecia.

But they are not medications for self-medication.

Their indication depends, among other factors, on sex, age, medical history, reproductive status, and type of alopecia.

In men with androgenetic alopecia, the available evidence particularly supports oral finasteride; other strategies require individualized assessment.

If we have telogen effluvium

Here the situation changes completely.

Telogen effluvium generally produces diffuse hair loss and can appear after certain triggers: an illness, surgery, childbirth, significant weight loss, nutritional restrictions, certain medications, or medical conditions.

In this case, our main goal is to identify and, where possible, correct the trigger.

We do not always need to immediately start pharmacological treatment.

If we suspect certain causes, the workup may include parameters related to iron or thyroid function, among others, depending on the clinical history.

And many forms of telogen effluvium can improve once the trigger disappears.

That is why I will dedicate another full article of The Doctor Explains to telogen effluvium.

What if it is alopecia areata?

Here we shift the treatment approach entirely once again.

Alopecia areata is an immune-mediated condition that typically produces clearly defined hairless areas.

In localised forms, for example, treatments with corticosteroids may be used; in extensive forms there are other therapeutic alternatives, including specific systemic treatments in selected patients.

This illustrates why simply buying an 'anti-hair loss product' without knowing which type of alopecia we have may make no sense at all.

What if iron is low?

If an iron deficiency exists, we need to correct it.

But here another common mistake arises: low iron can cause hair loss, but hair loss does not automatically mean low iron.

Ferritin is part of the workup in certain patients, but it must be interpreted within the clinical and laboratory context; when iron deficiency is suspected, other parameters of iron metabolism may also be useful.

That is why I do not recommend starting iron supplements simply because hair is falling out.

First, we check whether a deficiency truly exists.

Vitamins for hair loss: do they work?

This is one of the most common searches when hair loss begins.

And it's understandable: taking a capsule seems like a simple solution.

But vitamins for hair loss are not a universal treatment.

If a person has a nutritional deficiency, correcting it can be important.

But if their levels are normal, indiscriminately adding biotin, iron, zinc, or other micronutrients will not necessarily make more hair grow.

Furthermore, an excess of certain nutrients can also be harmful, and some excesses have even been linked to hair loss.

Supplementing a deficiency makes sense. Taking supplements without knowing whether that deficiency exists is another matter entirely.

Do anti-hair loss shampoos actually work?

A shampoo can be excellent for caring for the scalp.

It can help control oiliness, flaking, dermatitis, or cosmetically improve the appearance of the hair.

But we need to have realistic expectations.

A shampoo cannot, on its own, reverse the follicular miniaturization of androgenetic alopecia or rebuild a destroyed follicle.

Volumizing shampoos can make hair appear thicker, and certain products reduce breakage — but that is not the same as treating the underlying cause of alopecia.

What about PRP?

Platelet-rich plasma (PRP) involves drawing the patient's own blood, processing it to concentrate certain platelet components, and then administering it into the scalp.

There is evidence that it may be useful in certain patients with hair loss, especially as a complementary strategy, although protocols and outcomes can vary.

What matters, once again, is not to reverse the logic: diagnosis first, procedure second.

We do not perform PRP simply because someone is losing hair.

We first determine what type of hair loss the patient has, and then we assess whether they might benefit from it.

What about capillary mesotherapy?

Here we must be especially rigorous.

Under the term 'capillary mesotherapy,' a wide variety of products and combinations are marketed.

We cannot assume that any substance injected into the scalp is effective simply because it is called mesotherapy.

Each active ingredient requires its own evidence of efficacy and safety.

That is why, when we talk about hair medicine, I prefer to evaluate specific treatments and specific evidence, rather than simply commercial names.

Do lasers work for hair loss?

Photobiomodulation, or low-level laser therapy, has shown favorable results in some studies on hereditary alopecia, although the response is not universal and questions still remain about which patients benefit most and about the optimal protocols.

It can form part of a therapeutic strategy, but again it does not replace diagnosis, nor does it make all available devices equivalent.

Can a treatment combine several things?

Yes.

In fact, in certain types of alopecia it can make sense to combine treatments because they act through different mechanisms.

But more treatments does not necessarily mean better results.

A good hair care strategy does not consist of accumulating minoxidil + vitamins + PRP + mesotherapy + laser + supplements.

It consists of identifying: what condition we have, what mechanisms we want to address, and which intervention has sufficient evidence for that particular patient.

When do results start to show?

This point is essential to avoid abandoning effective treatments too soon.

Hair grows slowly.

That is why the results of many hair treatments must be evaluated over months, not days.

In androgenetic alopecia, for example, clinical guidelines typically assess the initial response to minoxidil at around six months; some results may require even longer.

Standardized photographs and trichoscopy allow for an objective comparison of progress over time.

Looking at yourself in the mirror every morning searching for new hairs is usually a very poor measurement tool.

Hair loss in women: is the treatment different?

It can be.

Hair loss in women requires taking into account particular situations: female androgenetic alopecia, telogen effluvium, pregnancy and the postpartum period, menstrual irregularities, menopause, possible nutritional deficiencies, or certain hormonal disorders.

Furthermore, some medications used to treat alopecia have important considerations related to pregnancy.

That is why we have dedicated a specific article in The Doctor Explains to 'Hair loss in women'.

So, what do we do in the consultation?

We do not start by choosing a product.

We start by trying to establish a diagnosis.

Clinical history. Scalp examination. Loss pattern. Trichoscopy when indicated.

And, if there are elements that justify it, a targeted blood panel or other tests.

A dermatological evaluation can make it possible to differentiate between various causes and determine when laboratory tests or, exceptionally, a biopsy are necessary.

Then we build the treatment.

What I want you to remember

If you Google 'treatment for hair loss', you will find hundreds of products: shampoos, vitamins, ampoules, lotions, minoxidil, injections, lasers.

But there is something Google cannot determine from that search alone: what is happening in your follicles.

And that completely changes the treatment.

That is why, when someone asks me: 'Doctor, what is the best treatment for hair loss?', my answer is: 'First tell me what type of hair loss you have.'

Because in hair medicine, the best treatment is not the one that is trending or the one that promises the most. It is the one that corresponds to the correct diagnosis.