I Tried Everything to Treat My Hair Loss (2024)

Over the last week alone, I’ve microneedled my hairline, caught up on emails while wearing a four-pound, red-light helmet, and stippled my scalp with mahogany makeup. All to grow—or look like I’ve grown—more hair. I’m not alone. The hair-restoration market (including oral medications, laser treatments, and hair-growth shampoos) reached a staggering $8.77 billion globally in 2023, according to market research company Grand View Research.

As a beauty journalist, I can offer recommendations for the best mascaras without skipping a beat. Struggling with melasma? I’ve got you. Not sure how to handle sudden breakouts? Come sit by me. But when it comes to thinning-hair advice, I'm just as mystified as the next person. I, too, am seduced by the before-and-after ads all over my Instagram feed. I've taken all the supplements and used the $100 shampoos. Rinse and repeat.

This personal expenditure of time and money was prompted by an image that’s now seared in my memory. While scrolling through photos from my husband’s birthday party last year, I noticed a balding woman in a dress that looked exactly like mine. It was an overhead view of the crowd. Could this be me? It was. My part had been widening for a year or so, but it was nothing a little dark brown makeup couldn’t fix. I had never seen this bird's-eye angle: It was clear my temples were receding, too, revealing parabola-shaped patches of scalp. What had happened to my shiny curtains of bouncy hair? Was this a medical problem? Did I need to have my thyroid checked? By 70, my grandmother had only a few wisps of blonde cotton candy on her head. I’m in my mid-40s. Maybe this was my genetic fate.

This one hit hard. Even in elementary school, when bullies mocked my buck teeth and glasses, I still won “Best Hair” in a 6th grade poll. Thick, shiny, generally obedient hair has just always been a given for me, the thing that drew compliments and ratcheted up my confidence. I could always rely on a good hair day, no matter what my complexion, waistline, or mood delivered that morning.

A widening part or receding hairline might seem trivial. After all, survival is not dependent on hair. But the emotional impact of losing it can be profound. “Hair loss can be a devastating experience. It can affect a woman’s self-esteem and sense of beauty, femininity, and desirability,” says Greta Angert, a Beverly Hills-based psychotherapist and body-image expert. In fact, studies show a correlation between hair loss and mental health issues like depression and anxiety, particularly in women. “It can be overwhelming and debilitating, leading some women to socially isolate,” Angert adds. Hair is so closely tied to our identity that women will go to great lengths to avoid losing it. Some 8% of cancer patients considered refusing chemotherapy specifically to preserve their hair, according to one study.

Throughout history, a healthy head of hair has been associated with female beauty. Before social media and the Breck girl told us we needed thick, glossy strands, we had Botticelli’s Venus and Rapunzel setting the beauty standard. The societal pressure dates back to biblical times. The phrase “crowning glory” comes from a verse in Corinthians: “If a woman has long hair, it is a glory unto her.”

As much as I wanted to rise above these millennia of beauty standards, I was gutted to see my once-glorious hair go poof before my eyes. So I decided it was time to untangle the mystery of my thinning hair and find where the prevailing research is leading us. After interviewing doctors and meeting with specialists, I got a lot of answers to my many, many questions.

1. Many things can cause hair loss—but most of us can blame one main factor. Or really, two.

Mom and Dad. The most common cause of hair loss has long been the same: genetics. But most of the doctors I spoke with agreed that both men and women are noticing signs of thinning earlier and earlier. They attribute this shift to factors like stress, diet, and excessive use of hair dyes and chemical processing. “There are more environmental factors playing a role now. We consume all these artificial foods, and they affect our bodies in meaningful ways, whether it’s increased aging or hair loss or the quality of the hairs themselves,” says Dhaval Bhanusali, MD, a board-certified dermatologist in New York City who specializes in hair loss.

There was also a new spotlight on hair loss during the pandemic. Scientists believe that the psychological stress of COVID-19 caused telogen effluvium, or hair shedding, to occur in some people. Telogen effluvium can also be caused by many other big stressors to the body, such as nutrient deficiencies, illness, high fevers, or childbirth. During telogen effluvium, 40% of the hair shifts out of the growing phase and into the resting phase, instead of the usual 10%. There is often a lag between the body-stress event and hair shedding because the resting phase typically lasts three months. Some people find that they don’t notice shedding until months after a major surgery, for example.

There’s been talk of GLP-1 and semaglutide drugs, like Ozempic, causing hair loss but there’s no evidence yet that thinning hair is a direct side effect of these medications. Rapid weight loss can lead to telogen effluvium, though. “It creates a shock to the body and shifts hairs into a resting phase,” says Santa Monica-based board-certified dermatologist Karyn Grossman, MD. Unlike other types of hair loss, telogen effluvium reverses on its own once the stressor that caused it is gone—in other words, after you recover from the illness or stabilize your body weight or address your vitamin deficiency.

Telogen effluvium would be a best-case scenario I thought as I made an appointment to see Carolyn Goh, MD, a board-certified dermatologist and director of the UCLA Hair and Scalp Disorder Clinic. Five vials of blood later, we found out that I had no underlying vitamin deficiencies that could be causing my hair to shed. Damn. “Everyone’s nutrient profile is different. I’ve had a ton of patients who respond quickly after we fix their vitamin D3 and ferritin,” says Dr. Bhanusali. Dr. Grossman says that she’s also seen plant-based diets give way to hair issues in recent years: “A lot of my vegan hair-loss patients don’t eat enough protein, so we do oral supplementation with plant-based collagen powders.”

I am not a vegan; my protein intake is just fine. And the blood tests showed my thyroid is normal as well—another potential cause off the table. Dr. Goh took a thorough history, then used a magnifying loupe to inspect my scalp, like a jeweler checking a diamond for inclusions. She poked around my scalp and snapped close-up photos. The verdict? “It’s female pattern hair loss, no question,” she told me.

Telltale signs of this chronic condition—also known as androgenetic alopecia—include overall sparseness and widening of the part, especially toward the back of the head, a pattern that specialists refer to as a Christmas tree. (Remember my overhead photo?) My diagnosis is the most common form of thinning among both women and men. It’s genetic. In other words, my DNA is programmed to start shortening the hair-growth phase and shrinking my follicles themselves so each strand is thinner, a process called follicular miniaturization. I’m in my 40s, right on schedule for the premenopausal hormone changes (a drop in estrogen and progesterone levels; an imbalance of testosterone) that kickstart this process, which Dr. Goh said will worsen over time without treatment. I left her office with five prescriptions—and hope. This wasn’t the news I wanted but I finally knew the cause of my hair loss and had a treatment plan to try to stop or at least slow down the thinning.

2. The earlier you start to address your hair loss, the better.

All of the experts I spoke to for this story said you should tackle the problem when you first notice signs of thinning. That doesn’t necessarily mean you should run to a doctor if your shower drain is clogged with hair, though. For perspective, it’s normal to shed 100 strands a day. So if you’re a busy mom who wears a lazy bun all weekend (raising hand), you’re likely to brush out 300 hairs by Monday. For my boob-length hair, that’s a golfball-size clump. If you’re shedding handfuls of hair at a time or notice bare patches of scalp in a party photo on the other hand, that’s a clear sign to go see a dermatologist.

Okay, back to early intervention: When follicles are still young and intact, you have a better shot at regrowing hair and improving the health of existing hair. “You want to start treatment while you still have a lot of hair. If you have a shiny cue ball scalp, you probably won’t get any growth because those hair follicles are so miniaturized that you can’t turn them around,” says Dr. Grossman.

“I always equate losing hair to a car going downhill. Everyone’s moving in that direction, but some people go faster, some people go slower,” adds Dr. Bhanusali. Look to your family to see just how quickly your own vehicle might accelerate. “I have a lot of patients who have rampant hair loss in their family and they’ll use over-the-counter minoxidil two or three times a week just to maintain their hair. And they do pretty well,” he says. “It’s much easier to maintain hair than it is to grow it back.”

3. Even after identifying the root cause of your hair loss, the solution is likely to be multifaceted.

My treatment plan from Dr. Goh is not a simple one. To address my androgenetic alopecia, she prescribed a daily dose of 0.625mg oral minoxidil, which sparks hair growth by dilating blood vessels to the scalp. You usually see results after four months. Lots of people use a topical version of the same ingredient (like Rogaine Women's 5% Minoxidil Foam), but I have an itchy scalp and Dr. Goh says that topical minoxidil could make my scalp even itchier and more irritated. (Hair loss is closely associated with chronic itchiness because inflammation obstructs hair growth causing hair to fall out.) A potential downside of oral minoxidil? Extra peach fuzz on the face and rogue hairs on the nipples or stomach. “Some people are bothered by it and a lot of people just say, ‘Eh, I’ll shave or pluck it,’” Dr. Goh says. I’m taking my chances.

My second prescription: spironolactone, one 50mg tablet daily. Spironolactone slows down the production of androgens, hormones that help control the hair growth cycle. Androgenetic alopecia is caused by an excessive response to androgens that results in hair loss. One study found that almost 75% of women with genetic hair loss noticed an improvement after taking spironolactone for seven months. Another study showed that women with genetic hair loss saw significant improvement after six months of taking a combination of oral minoxidil and spironolactone. This is a cocktail I can get behind.

Next up is topical fluocinolone acetonide 0.01%, a serum-y steroid solution that will reduce my itching and inflammation. I’m supposed to massage a few drops into my scalp, up to twice a day when I’m feeling particularly itchy. Dr. Goh also prescribed a 2% ketoconazole shampoo to help stimulate hair regrowth. Even though the FDA hasn’t approved the ingredient for hair loss, dermatologists have recently been praising its off-label use. And so far, one study has found that regular use of prescription-strength 2% ketoconazole increased hair shaft size, leading to a fuller head of hair. You can find lower concentrations of ketoconazole in over-the-counter products like Nizoral Anti-Dandruff Shampoo 1% Ketoconazole.

Finasteride (an oral medication known as Propecia) is another effective treatment for hair loss, but Dr. Goh says that I’m not a candidate. I still get regular periods and finasteride is not recommended for women of childbearing age because of the risk of birth defects. While spironolactone slows down the production of androgens, medications like finasteride and dutasteride block androgens from binding to the hair follicles and accelerating hair loss.

Hair-growth supplements, like Nutrafol and Viviscal, got mixed reviews from Dr. Goh and the other experts I talked to. Most said that supplements can’t hurt as an adjunct to other treatments but there’s not much evidence that they’ll move the needle. “A lot of supplements are overpriced for what they deliver, to be honest with you,” says Dr. Bhanusali, adding that some of the studies on their efficacy are sponsored, meaning the research is funded by brands that benefit from favorable results. “I’m not so thrilled with the data from some of the studies that have been published,” he says. “Do I think these supplements help? Maybe. Do I think they hurt? Probably not.”

With a proven treatment plan in place, I decided I was done with the pricey supplements. However, Dr. Goh did advise me to continue using my red-light helmet at home for 15 to 20 minutes a day to boost the blood supply to my scalp. Low-level infrared light treatments (specifically, a wavelength range of 650 to 950 nanometers with at least 120 LED diode bulbs for full scalp coverage) have been shown to stimulate tissue repair and hair regeneration after four months of daily use. I have the CurrentBody LED Hair Growth Helmet ($859), which makes me feel like a Star Wars stormtrooper. My kids are into it.

But there are less-expensive devices that fit the criteria, like HighDose’s new red-light hat (recently spotted on Courteney Cox), which is more of an inconspicuous baseball cap than sci-fi villain attire. “I do think red light works and it’s another tool in your tool belt,” adds Dr. Bhanusali, who uses red-light treatments on patients in his office. “If you have irritation or inflamed follicles, the red light puts out the fire a little bit. If you try to grow plants in lava, it’ll never happen.” In one study, the combination of red-light therapy, topical minoxidil, and oral finasteride was found to improve hair density and strength around the temples by 55% in women and 74% in men.

Some in-office lasers can tackle hair loss and some of the newer treatments don’t involve pain or downtime. Earlier laser treatments caused stinging and prickling sensations and required numbing. Dr. Grossman recommends Folix by Lumenis, a laser that was recently FDA-cleared (as opposed to “approved,” which would mean the FDA evaluated its efficacy, not just its safety) for stimulating hair growth. “It increases blood flow to the scalp which then creates an influx of growth factors into the local area,” she says. You’ll spend around $2,400, depending on where you live, for a series of three treatments. The AlmaTED device emits ultrasound waves to stimulate the scalp while using air pressure to open up hair follicle channels. “Once those channels are open, you can apply a cocktail of growth factors, peptides, and antioxidants that can help stimulate the hair growth cycle,” says Beverly Hills-based, double board-certified plastic surgeon and hair-restoration surgeon Jason Champagne, MD. His patients typically notice the results after three monthly treatments, at $1,000 to $1,500 a pop.

Not all doctors are convinced these costs are worth it, though. “I haven’t seen any good evidence [from using lasers in general]. Until I see that, I tell people to save their money,” says Dr. Bhanusali. “If your doctor is trying to push expensive things right off the bat, then run. First, do the basics and try to rule things out.”

Some doctors are injecting actives directly into the scalp. Dr. Champagne reports that his patients have seen an improvement in hair growth and thickness when Botox is injected into the thin muscles surrounding the scalp. One small study published in 2017 found the same result, though much more research is needed. In theory, relaxing these muscles improves blood flow throughout the area and increases oxygen and nutrient levels around hair roots. Dr. Bhanusali injects a steroid, like Kenalog, into the scalp for patients with telogen effluvium or inflammation. “Especially with my post-pregnancy patients who have a propensity to lose a lot of hair, I like to do Kenalog in very small amounts and add LED red light because of the anti-inflammatory aspects. There’s some debate over whether telogen effluvium is actually inflammatory and I think it is because the patients seem to do pretty well,” he says.

4. Misdiagnosis is common in BIPOC women.

I was able to get an accurate diagnosis pretty quickly, but the experts I spoke with for this story told me that women of color are not always so lucky. It’s difficult for some dermatologists to pick up on race-specific hair loss because the nuances aren’t readily known throughout the medical community, according to Crystal Aguh, MD, associate professor of dermatology and director of the Ethnic Skin Program at Johns Hopkins School of Medicine: “We need to incorporate [conditions specific to textured hair] into our training and textbooks and make them a standard part of the curriculum.”

Familiarity with Black hair culture also plays a role in treating hair loss in women of color. For example, extensions, braids, weaves, and wigs can cause intense pulling at the scalp often resulting in traction alopecia, which is different from other forms of alopecia because it’s caused by prolonged tension on the hair. “In my alopecia clinic, a substantial portion of patients suffer from traction alopecia,” says Dr. Aguh, adding that the condition typically presents as a receding hairline and overall thinning. “By the time women come to see me in their 30s and 40s, extensions are the only thing they’ve ever done with their hair,” she says. “If you can wear your own hair and make it healthy, you will have a better outcome.”

Dr. Aguh, author of the 90 Days to Beautiful Hair book series, debunks the myth that relaxers permanently damage follicles. “You’re less likely to get alopecia from using a relaxer than from wearing braids,” she says. (But given that recent studies have linked chemical hair straighteners to reproductive disorders and cancer, there may be other reasons to avoid using them.)

5. A hair transplant can be effective, but it’s not a one-and-done solution.

I’m optimistic about my current hair-loss treatment regimen, but that doesn’t mean I’m not also thinking about what future treatment might look like if I need it. The hair-loss brain trust I tapped into for this story told me that if you’ve tried a combination of minoxidil, spironolactone, or finasteride, and red-light therapy for at least a year and see no improvement, it might be worth considering surgical intervention. In hair-restoration surgery, active follicles are moved from the back of the scalp to areas where the hair is thinning. Even after the surgery, though, you need to be diligent with a maintenance program. Dr. Champagne encourages his patients to continue oral medications like spironolactone, in-office laser treatments, and red-light therapy to keep transplanted hairs healthy. “If you have weak hair, those follicles may not survive the transplantation process because we're taking them away from their blood supply where they’re happily living and putting them in a new environment,” he says. It’s also worth noting that if your hair loss is due to androgenetic alopecia, you might continue to lose hair even after it’s transplanted, so you should come up with a long-term plan with your doctor. “I like to involve the dermatologist early on because I don’t treat medical causes of hair loss. I’m a hair restoration surgeon for patients who have already seen dermatologists and have already done the preemptive work,” says Dr. Champagne.

Unlike early surgical techniques, today’s hair transplants don't involve stitches. Follicles are harvested in groups of one to three hairs at a time. A circular blade cuts out 1 mm. sections of scalp (about the size of a sharp pencil point); tweezers are used to remove the tiny graft. The follicles are then separated and implanted in the new site. The procedure is typically performed under local anesthesia and you can return to work in as little as 48 hours. But there’s an art to getting it right. “Good results are a thousand percent dependent on your doctor. You have to be thoughtful about how you’re designing that hairline,” says Dr. Grossman.

“We all have cowlicks and areas where the hair grows in different directions. I’m making sure that each hair is turned in the right direction in my recipient sites and that each hair will grow in the flow of the natural hair growth pattern,” adds Dr. Champagne. Earlier hair transplant surgeries were less refined. Doctors either surgically cut out strips of scalp and sewed them into a new area, or they removed a graft of hair the size of a pencil eraser (the equivalent of 20-30 hairs) using a hole-punching tool and stitched each plug into a new location. The result looked like unnatural doll hair with telltale chunky tufts. Those surgeries were painful and the results were unpredictable.

Before you commit to a transplant surgeon, make sure you see their before-and-afters for patients with your hair type, especially photos taken a year after the procedure when final results should be on full display. lf you have curly or textured hair, follicle extraction can be tricky. The hair curls both above the scalp and below its surface, making it more challenging to harvest and transplant. “It’s important to have an understanding of the hair type and how it grows in the scalp because you obviously can't see a curl below the skin with the naked eye,” says Dr. Champagne. “Otherwise, you’re going to cut across the root and damage that follicle, which is wasting the follicle.”

A note of cosmetic caution: The donor area needs to be completely shaved down, so be prepared for awkward regrowth. (This isn’t usually an issue for men with short hair. It would be for me.) Also, your newly implanted hairs don’t stick around for very long. They usually fall out two weeks after the procedure, which is totally normal. The follicles will start producing new hair within three to four months. Transplant surgery can cost between $4,000 and $20,000, depending on the extent of hair loss and the number of follicles transplanted.

6. Exosomes could help—but they’re not all created equal or without risk.

Exosomes—a type of molecule found in nearly all cells that helps transmit messages between them—have been at the forefront of regenerative medicine for a few years. Exosomes can be derived from different sources, like a patient’s own body, tissue from other humans and animals, or plants, and they can be trained to deliver all sorts of messages to the body. In the case of hair growth, they can switch on a phase of the hair-growth cycle, speed up scalp healing, or tell healthy cells to regenerate. “Exosome therapy is working really well for a lot of my patients, who have seen significant thickening of their hair after treatment,” says Dr. Champagne. “By injecting exosomes into the scalp, we are able to reverse dormant hair in the telogen phase back to the healthier anagen growth phase.” The cost for one session of exosome hair-restoration therapy can range from $2,000 to $15,000 per treatment.

For a few months, I road tested an over-the-counter exosome treatment called Calecim Advanced Hair System ($360), which includes a home microneedle stamp and serum. The key ingredient, PTT-6, is made from growth factors that the company claims are humanely sourced from deer umbilical cords after birth. The formula itself, they say, will increase hair growth and decrease scalp inflammation after 12 weeks of use. I can’t say that it made a big difference, although I did notice some new baby-fine hairs along my hairline.

While some research has shown that exosome therapy can be effective in treating alopecia, the medical community isn’t all in just yet. Of the five doctors I spoke with, Dr. Champagne is the only one administering it in his practice. The quality and safety of exosomes are not regulated, and the Centers for Disease Control has reported that about six years ago several people in Nebraska developed bacterial infections and sepsis as a result of unapproved exosome therapy treatments. “There was a lot of controversy about exosomes at this year’s American Academy of Dermatology meeting,” says Dr. Grossman. “There are still a lot of questions. Even though a lot of people are injecting exosomes in the scalp they are not FDA-cleared, so if something happens to a patient, you don’t have a leg to stand on.” In its most recent statement on regenerative medicine products, the FDA made it very clear it is not yet on board with this technology: “Exosome products are regulated by the FDA and there are currently no FDA-approved exosome products.”

In contrast to exosomes, platelet-rich plasma (PRP) is separated from your own blood in a centrifuge before it is injected back into your scalp. The white blood cells and platelets are rich in growth factors, which help stimulate hair follicle activity and prompt new hair to sprout. “PRP therapy helps with hair loss and hair thickness. We have a lot of models and actresses who come in for PRP just for hair quality, especially if they’re getting their hair straightened and styled all the time,” says Dr. Bhanusali, who recommends a series of three treatments, spaced four to six weeks apart. Each treatment can cost between $500 and $2,500, depending on the treatment area. "The data shows that you should do a set of three treatments each year in perpetuity,” says Dr. Bhanusali.

7. Cloning and follicle banking have entered the chat.

Hair cloning is not a new concept. For over 50 years, scientists have unsuccessfully tried to replicate hair follicle cells in a lab and inject them back into the same patient’s scalp. “They’ve been saying hair cloning is five years away for the last 25 years,” says Dr. Bhanusali. “The biggest issue is legal hurdles and regulation in the United States. They’re doing a lot of the work in Europe. If I were to guess, it’s maybe 10 years away. I’m hopeful, but I'm not necessarily confident.”

That said, new research is focusing on cloning dermal papillae cells, which play a pivotal role in hair formation, growth, and cycling. Cells in the hair root are isolated, cultured in a lab, and multiplied. Located at the bottom of hair follicles, these cells are known to thicken existing hair. British hair research company HairClone is currently conducting clinical research on patients overseas.

Hair banking is another emerging treatment possibility. Can you cryopreserve hair follicles when you’re young to use as an insurance policy later? Maybe. Similar to freezing embryos for a potential future pregnancy, scientists believe you can surgically extract a cluster of young follicles and preserve them in a tissue bank, giving patients an opportunity (not a guarantee) to optimize hair regrowth in the future. Cryopreserving tissue stops biological aging, so this process could theoretically preserve hair follicles in a young, healthy state. HairClone technology is still in development in the United Kingdom; a company called Acorn Biolabs is in the midst of the same pursuit in the United States and Canada.

8. Commitment is key.

By all accounts, the secret to getting the best head of hair for your buck is daily diligence. My new hair-restoration routine is now more elaborate than a Gen Alpha #GRWM TikTok. It involves swallowing two pills every morning; massaging a clear, watery serum into my scalp twice a day when it feels itchy; lathering my scalp (but not hair) with a red maple syrup-like shampoo twice a week and walking around my house on a daily basis in a stormtrooper helmet. And I can’t slack off—even in response to positive results. “People need to understand that hair loss is a disease. If you stop treatment, the hair is going to slowly fall out again because we haven’t changed your genes. This is your underlying genetic makeup,” cautions Dr. Grossman. “You need to be growing hair like taking care of a garden. You have to water your garden regularly and then you need to fertilize it intermittently.”

It’s also important to manage your expectations. “We all have different baseline hair densities and hair thickness. Some people want thick hair and they’ve had very thin hair their whole lives. We can’t do that yet," Dr. Grossman says.

So it looks like I’m going to be in a long-term relationship with the pharmacist at CVS. Right now, I'm in the waiting period. About 12 weeks into my treatment plan, I’m noticing a few new baby hairs and soft shading where there used to be obvious scalp. My hair is a bit shinier and softer, too. This is the ambiguous “Is it or isn’t it?” phase and I have to remind myself that this is a process. I’ve spent far too much time staring at my scalp, willing new hairs to sprout from it. It's hard to pinpoint which hair-loss medications or treatments are most effective, but it's likely that the best results come from using a combination of methods.

“Some people are like, ‘I really don’t want to be taking prescription medication for the rest of my life,’ because these are rest-of-your-life commitments,” says Dr. Grossman. I am not one of those people. If it means more hair for years, I am willing to swallow the pills, to use the serum, to swear off ponytails. And the giant LED helmet? It'll be my plus-one when I travel this Thanksgiving.

Read more about hair loss:

• After Hair Loss, I Learned to Love Myself Again
• 13 Best Shampoos for Thinning Hair, According to Dermatologists
• Every Single Thing That Happened During My Hair Transplant

Watch Brooke Shields' hair routine:

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