​Hair Loss Shampoo (and Other Topical Products)

Written by Jolene Bressi, PharmD / Medically reviewed by Dr. Ashley Steffens

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HairScience Score

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  • No approved products for hair loss
  • Should be used with other treatment
  • Oils and lotions are usually more effective

Applied every 1-7 days*


*Use determined by hair type

​Hair Growth Shampoo (and Other Products)

Can Shampoo Really Improve Hair Growth?

Shampoos have the potential to help improve hair growth. How much they can help depends on the ingredients in the shampoo you’re using and the cause of your hair loss. Some key shampoo ingredients that have been linked to hair growth in various types of hair loss are (9,22,23,27):

  • Caffeine
  • Ginseng
  • Saw palmetto
  • Green tea
  • Licorice
  • Lindera strychnifolia root extract
  • Piroctone olamine
  • Zinc pyrithione
  • Ketoconazole

Ketoconazole shampoo is the most well-studied of these products. (47) However, it is only FDA-approved to treat fungal skin infections (specifically, a condition called tinea versicolor). (10)

There are no FDA-approved shampoos for hair regrowth. This is partly because the active ingredients in shampoos are often of natural origin. Studies indicating the effectiveness of natural products exist, but natural products and ingredients are considered supplements. As such, they are not subject to FDA approval. 

What Ingredients in Shampoo Promote Hair Growth?

Many products claim to promote hair growth. But buyer beware: cosmetic products like shampoos are not created equal. Since the FDA does not regulate these products, safety and effectiveness can vary widely. 

The cause of hair loss determines which active ingredients will be effective. Multiple factors, including hormones, inflammation, and scalp health, have been linked to reduced hair growth. Useful shampoos aim to target at least a few of these factors. (48,49)

A healthy scalp is fundamental for healthy hair growth, and an imbalance in the scalp’s microflora is a major contributing factor to hair loss. Scientific research has mostly overlooked the scalp’s microflora in fostering a healthy hair environment. However, many hair care products help balance the scalp microbiome. This helps decrease inflammation that can cause hair loss. (12)

Several over-the-counter products help balance the scalp’s microflora and treat related skin issues, like dandruff. These include shampoos with ingredients like ketoconazole, zinc pyrithione, and piroctone olamine, which may help decrease hair shedding. (9)

Some individuals prefer natural oil or herbal medications over pharmaceutically prepared products. Many of these all-natural products are rich in antioxidants and have antimicrobial properties. These natural oils and herbal remedies account for up to 80 percent of the developing world’s basic health care needs. (40)

Several natural products, including saw palmetto, green tea, and potentially even licorice, can inhibit dihydrotestosterone (DHT), the primary hormone associated with pattern hair loss. These ingredients are available in shampoo formulations and have been clinically shown to promote hair growth! (27) 

In addition, many herbal compounds common to Eastern medicine have been linked to hair growth, including (40):

  • Jatamansi
  • Bibhitaki
  • Giant Dodder
  • Shrubby sophora
  • Onion juice
  • False daisy
  • Polyporus umbellatus
  • Ramie
  • Knotweed 
  • Tridax daisy/Coatbuttons

Can Any Oils Improve Hair Growth?

Natural oils have also shown promise in promoting healthy hair growth. Oils that may help hair growth include:

  • Pumpkin seed oil
  • Rosemary oil
  • Tea Tree oil
  • Thyme oil
  • Lavender oil
  • Evening primrose oil
  • Atlas cedarwood oil

Pumpkin seed oil, rosemary oil, and tea tree oil have been studied in independent trials. They have all shown effectiveness in improving hair growth.

When tested against a placebo, pumpkin seed oil was notably more effective and increased hair count at 12 and 24 weeks. Similarly, a patient-blinded head-to-head study compared rosemary oil to 2 percent minoxidil. Both products showed efficacy in combating androgenic alopecia, but participants were more likely to use rosemary oil.

Oils have also been tested in combination with hair loss treatments. In one study, people with hair loss were given tea tree oil, 5 percent minoxidil (the active ingredient in Rogaine), and diclofenac (a topical anti-inflammatory gel). People who used tea tree oil, minoxidil, and diclofenac had better and faster results than those who used minoxidil alone. They also experienced fewer side effects!

Combinations of oils have also been blended and assessed as hair loss treatments. In two studies treating patients with alopecia areata, thyme oil, lavender oil, evening primrose oil, and atlas cedarwood oil were mixed with other carrier oils.

These two head-to-head trials compared this blend with a carrier-oil-only placebo. In one study, 75 percent of participants using the essential oil blend had hair growth! The essential oil group’s hair growth was significantly higher than the placebo group’s.  In the other study, 44 percent of the essential oil group had hair growth. (13)

Shampoos to Thicken Hair

What Is Hair Thickening Shampoo?

Shampoos are the most popular hair care product worldwide, with approximately 4 billion bottles sold every year! (14) All shampoos clean the hair and scalp by removing dirt and oil (sebum). Sebum removal helps prevent scalp conditions such as folliculitis and seborrheic dermatitis. (20)

Some shampoos take things a step further, adding ingredients that can improve the look of hair. (14) One type of advertised improvement is the ability to thicken hair.

Hair thickening shampoo not only removes grease and dirt but deposits ingredients, like polymers, that plump up each hair follicle. (21) However, this effect is usually short-lived, as few polymers enter the hair follicle to improve hair growth.  

One polymer that is meant to benefit skin and hair health is silicone. It’s been shown to improve strength and elasticity, and increased silicone concentrations may also decrease hair loss. Higher concentrations of silicone in hair fibers may lower rates of hair loss and increase brightness. Unlike other polymers, silicone can penetrate hair follicles, entering the hair shaft and root. Since silicone prevents hair breakage, this results in thicker, stronger hair. 

However, silicone’s beneficial effects have not been scientifically proven in placebo-controlled, double-blinded studies. Instead, they’ve been suggested based on the way polymers function. Silicone’s impact can also vary based on its concentration within your hair product. (15)

Shampoo can also pump up your hair’s volume by counteracting the effects of dihydrotestosterone (DHT). DHT is a naturally occurring hormone present in both men and women. It’s made from the conversion of testosterone.

DHT is linked to hair loss and is known to shrink hair follicles. DHT-blocking shampoo can counteract this process, resulting in improved hair thickness! Anti-DHT shampoo might contain DHT blockers like ketoconazole, saw palmetto, green tea, and caffeine. (2,22,27)

Be cautious of products claiming to improve hair thickness, as there is very little science to back this up. Volumizing claims may be more accurate. These claims are based on the shampoo’s alkalinity or acidity, which can be verified by researching the pH of the product.

Can Shampoo Make Your Hair Thicker?

Hair thickening shampoo can plump hair in two ways. Some products labeled as thickening or volumizing shampoos contain polymers. These polymers are deposited when the shampoo is used, giving a temporary plumping effect. (14) Many products fall into this first category.

Shampoo can also enhance thickness by counteracting the effects of dihydrotestosterone (a hormone commonly known as DHT). DHT shrinks hair follicles, resulting in reduced hair thickness. Both prescription and natural DHT blockers can stop and counteract this issue.

Natural DHT-blocking ingredients you may find in shampoos include saw palmetto, green tea, and caffeine. Ketoconazole shampoo also counteracts DHT-induced follicle miniaturization. The effectiveness of anti-DHT shampoo lasts as long as you use the product. It generally takes several months to start to see results. (2,22,27)

Beware of products that claim to increase hair thickness! They may only provide temporary results that go away when you wash them off or stop using the product. Long-term hair thickness improvements are most likely if an underlying condition, like pattern hair loss or seborrheic dermatitis, is causing the follicles to produce thinner hairs.

What Is Volumizing Shampoo?

The words thickening and volumizing are often used interchangeably. However, they are slightly different terms. Volume refers to the amount of space a grouping of hair takes up in a defined space — how thick or dense your hairs appear to be. Thickness refers to the amount of space one hair occupies — essentially, each strand’s diameter. (18)

Anti-DHT and polymer-rich shampoos can make hair thicker, but they won’t always increase hair volume. The easiest way to increase hair volume is to choose a shampoo with the right pH.

The term pH refers to how acidic or alkaline something is. The pH of your scalp is 5.5, while the pH of your hair shaft is 3.67. Shampoos with a pH below 5.5 are thought to help protect hair and may even have volumizing properties.

The pH of shampoos can vary a great deal. Changes in pH can influence the static electrical properties of the hair shaft, increasing the space between each hair.

Most salon products have a pH at or below 5.5. In contrast, higher pH shampoos have been associated with frizz, hair breakage, and increased tangling. Higher pH shampoos also tend to require the use of a conditioner. However, conditioners can aggravate scalp conditions like seborrheic dermatitis.

The pH of your shampoo is important, but this information isn’t often found on the label. If you want to find out more about your shampoo’s acidity or alkalinity, check the product’s website or call the manufacturer. (19)

Can Any Other Products Thicken Hair?

There are plenty of creams, gels, and other products that claim to thicken hair. Most of these products contain polymers (a molecule with many similar bonded units).

Polymers may provide a temporary plumping effect, but results are temporary and go away when you wash them out. Caution should be used when choosing a product as some can make hair look visibly greasy, sticky, or limp. (18) You should also be aware that some polymers can cause product buildup, trapping dirt and germs on the scalp. This can be bad for both scalp and hair health.

By increasing hair growth or preventing hair loss, hair can appear thicker. Ketoconazole is an ingredient with anti-inflammatory, anti-DHT, and antimicrobial properties that can improve scalp health. DHT (Dihydrotestosterone), a hormone linked to pattern baldness, causes miniaturization of hair follicles. Ketoconazole shampoo can help counteract the negative effects of DHT and balance the scalp microflora. (1) Ketoconazole is also available as a cream, foam, or gel.

Garlic gel (at a 5 percent concentration) also has antimicrobial properties. In one trial, it helped regrow hair in 95 percent of people with alopecia areata by normalizing scalp microflora. However, it’s important to note that trial participants used a topical prescription steroid while using garlic gel. (24)

Shampoos for Hair Loss

Can Shampoos Stop Hair Loss?

All shampoos can clean hair, but choosing one that works well for your hair and skin can be confusing. You want to pick a product that matches your hair type to achieve optimal oil removal without stripping too much away.

There are ten basic types of shampoo (20):

  • Normal hair shampoo
  • Dry hair shampoo
  • Damaged hair shampoo
  • Oily hair shampoo
  • Everyday shampoo (which is gentler than normal hair shampoo)
  • Deep cleaning shampoo
  • Baby shampoo
  • Medicated shampoo
  • Two-in-one shampoo
  • Hair dyeing shampoo

As you can see, hair loss shampoo is not on this list. The next time you’re thinking, “what kind of shampoo should I use for hair loss?”, you’ll remember that there’s no Food and Drug Administration (FDA) or European Medicines Agency (EMA) approved hair restoration shampoo.

That being said, some of these shampoos can help counteract hair loss. Ketoconazole shampoo, a type of medicated shampoo, has shown the best efficacy for stopping hair loss. It has proven effective when treating an underlying scalp condition such as seborrheic dermatitis and pattern baldness. (1,7)

Having a healthy scalp is the first step in achieving healthy hair. Ketoconazole shampoo has antimicrobial, anti-androgenic (DHT blocking), and anti-inflammatory properties that help improve scalp health and hair growth.

Ketoconazole shampoo is available over the counter as a 1 percent shampoo.  It is also available as a 2 percent shampoo when prescribed by your doctor. Unlike most other products, ketoconazole shampoo should be lathered on and remain on your scalp for 5 minutes before you rinse.  (1)

Another exciting shampoo that has shown promise in preventing hair loss is caffeine shampoo. Caffeine increases cell metabolism to counteract the harmful effects of dihydrotestosterone (DHT), a  hormone linked to hair loss.

Hair follicles can absorb caffeine after just 2 minutes of topical application. This makes it ideal for use in shampoos, which are typically only in contact with the skin for a short period. (22) Other natural ingredients with anti-DHT properties that can be found in shampoos include saw palmetto and green tea. (2)

What Is Ketoconazole Shampoo? Can It Help With Hair Loss?

Ketoconazole is a topical medication with antimicrobial, anti-inflammatory, and anti-androgenic properties. (1,2) It’s been shown to help people with multiple types of hair and skin problems, including hair loss due to androgenic alopecia (pattern baldness), fungal infections, and seborrheic dermatitis. Ketoconazole works by improving the scalp microflora and reducing inflammation caused by microflora imbalance. (1,8)

Topical ketoconazole effectively treats scalp issues like seborrheic dermatitis and fungal infections (tinea versicolor). These types of hair loss have been linked to Malassezia-related conditions (a type of yeast infection). Yeast infections can occur to anyone, but they are more likely to affect people with pre-existing conditions that compromise their immune systems.

Several factors cause androgenic alopecia. These include genetics, androgens (specifically dihydrotestosterone, commonly known as DHT), and inflammation surrounding hair follicles.

DHT causes miniaturization, where hair follicles shrink and produce thinner, weaker hairs. Ketoconazole has been shown to counteract the miniaturization process, leading to increased hair growth and follicular volume. (9) Pattern baldness caused by these superficial infections in combination with excess DHT has been particularly responsive to ketoconazole since it has both anti-androgenic and anti-microbial properties.

Ketoconazole is available in several different dosage forms (cream, foam, gel, and shampoo) and in two different strengths (1 percent and 2 percent). Ketoconazole 1 percent is available over the counter, while 2 percent ketoconazole is only available with a prescription. (3) Talk to your healthcare provider to decide which option is best for you.

What Is Minoxidil Shampoo? Can It Help With Hair Loss?

Minoxidil shampoo is not a Food and Drug Administration (FDA) or European Medicines Agency (EMA) approved formulation. Limited information is available regarding its effectiveness. 

When studied in a 4-month clinical trial, minoxidil shampoo did not show significant hair growth over placebo. (42) Although this product is sold in foreign markets such as China or Brazil, it is important to note that it does not have FDA or EMA approval in a shampoo formulation. (37,38)

Minoxidil foams and serums are not the same as minoxidil shampoo. These topical minoxidil products are FDA-approved to help counteract pattern hair loss in men and women. The approved formulations of minoxidil are a 5 percent foam for use in both men and women, a 5 percent solution for use in men, and a 2 percent solution for use in women. Minoxidil 5 percent formulations are shown to be more effective than minoxidil 2 percent. (6)

All FDA-approved topical formulations are applied onto a dry scalp where you want to see hair regrow. In contrast, shampoo is used on wet hair and washed off within minutes. It is unlikely for this formulation of minoxidil to be very effective since it needs to remain on your scalp longer than a few minutes to provide maximal benefit. (42)

What Is Anti-DHT Shampoo? Can It Help With Hair Loss?

Dihydrotestosterone (DHT) is a hormone made from the conversion of testosterone. DHT is the main hormone involved in pattern baldness.

Excess DHT shortens the hair growth cycle, increasing hair shedding. Increased DHT levels also lead to hair follicle miniaturization, resulting in the production of thinner, smaller hairs. By blocking this naturally occurring process, anti-DHT products can help prevent hair loss symptoms, including miniaturization and increased shedding. (6,46)

Saw-palmetto, caffeine, green tea, and ketoconazole are all available in shampoo formulations and have anti-DHT properties. These products are all available without a prescription. (1,23)

Can You Use Dry Shampoo for Hair Loss?

Not all shampoos are created equally. Products like dry shampoo make your hair look clean and voluminous, even when your hair is thinning or greasy. They can also knock a bunch of time off your morning routine. You might even believe they improve hair health, since some producers add in essential nutrients in order to claim that their dry shampoo can regrow hair.

Despite these tempting positives, dry shampoo should not be used to combat hair loss. In fact, when used excessively, this product may lead to scalp irritation and hair loss.

Dry shampoo acts to absorb oil, and most products are sold as aerosol powders. Once sprayed on hair roots, the powder binds with naturally produced oils. (53) This can cause an excess of powder, oil, and environmental dirt to build up on the surface of your scalp.

Build-up can lead to itchiness and scalp irritation that can affect your hair follicles. If you have sensitive skin, this can be made even worse by contact allergens found in dry shampoo products. (53) While harmless to some, these ingredients can cause dermatitis that results in hair loss in some people. 

The next time you think, “can my shampoo cause hair loss?”, think twice before skipping a thorough wash with your regular shampoo. Cleaning your scalp regularly is good for your hair follicles. Swapping a wash for dry shampoo too often could contribute to hair loss.

What Shampoo Should You Use for Hair Loss?

Ketoconazole shampoo has shown positive results in combating hair loss. Although it’s not specifically indicated for this purpose, studies have shown it’s effective at fighting hair loss, especially for individuals with underlying scalp issues such as seborrheic dermatitis. Having a healthy scalp is crucial to having healthy hair. (1)

Ketoconazole shampoo is regulated by the Food and Drug Administration (FDA) and European Medicines Agency (EMA). It’s available without a prescription as a 1 percent shampoo. Your healthcare provider can also prescribe a 2 percent version of this product.

Caffeine shampoo also shows promise in the fight to combat hair loss. It’s easily absorbed by the hair follicle and helps fight the harmful effects of DHT, a hormone linked to pattern baldness. Like all hair loss products, it is crucial to use the product regularly (at least several times per week) to see the maximal benefits. (22)

There are several other natural products used in anti-DHT shampoo. Saw palmetto and green tea have shown effectiveness in blocking DHT and are incorporated into shampoo formulations. (27)

Caffeine, saw palmetto, and green tea shampoos are natural products and are not subject to FDA or EMA labeling guidelines. However, not all ingredients in these shampoos come from natural sources. It is important to buy these products from a reliable manufacturer. Both the contents and concentration can vary, which means that no two shampoos are likely to be exactly the same. (1,27)

Are Shampoos for Hair Loss Worth the Cost?

There is a huge price differential to consider when choosing the right hair care products for your particular needs. Some products, like ketoconazole shampoo, may cost more, but they are likely worth the cost as they have clinically proven benefits. On the other hand, minoxidil shampoo shows minimal effectiveness. You’re better off spending your money on an FDA-approved formulation, like the 2 percent and 5 percent foams or serums. (1,42)

Other natural products that have shown effectiveness can also be used in hopes of seeing a greater effect on hair growth. Caffeinated shampoo is particularly interesting as it blocks the main hormone involved in pattern hair loss and is easy to find online. Some of these products may cost more than regular store brand shampoos, but clinical studies show caffeinated shampoos provide major benefits and have few risks. Just keep in mind that the concentration can vary, which means that no two shampoos are likely to be exactly the same. (22)

Creams, Gels, and Oils for Hair Loss

Can Any Hair Creams, Gels, or Oils Stop Hair Loss?

Many hair creams, gels, and oils can help counteract hair loss. Some of these are based on natural ingredients, while others contain beneficial polymers or medicated ingredients.

One polymer, Polyquaternium-74, has volumizing, antimicrobial, restorative, moisturizing, shine enhancement, and color protection properties. This interesting polymer has matched or outperformed other polymers at detangling, conditioning, shine enhancement, and buildup reduction.

Another unique polymer that helps protect hair fibers by blocking harmful UV rays is polysilicone-19. UV rays from the sun and heat from styling tools damage hair, making it less able to retain moisture and more susceptible to environmental damage. (21)

Topical steroid creams such as clobetasol and betamethasone can help combat hair loss caused by an overactive immune response. Although our immune system is meant to keep us healthy, it can also overreact and cause damage to healthy hair follicles. Topical steroid creams help decrease inflammation, as seen in conditions like psoriasis and alopecia areata. (25,26)

Many natural products, like herbal and essential oils, can also help with hair loss. These ingredients are infused into conditioners, masks, sprays, hair oils, and sometimes even shampoos. Keep an eye out for ingredients like:

  • Saw palmetto extract
  • Green tea extract
  • Rosemary oil
  • Pumpkin seed oil
  • Grapeseed oil
  • Onion juice
  • Garlic gel
  • Caffeine
  • Procyanidin (a type of flavonoid)
  • Curcumin

While all of these natural ingredients can positively affect hair growth, they don’t all work in the same way. For example, saw palmetto, caffeine, green tea, and pumpkin seed oil all block dihydrotestosterone (DHT), the primary hormone involved in pattern hair loss. Rosemary oil and caffeine have also been shown to increase circulation. (27) Garlic gel can help improve scalp health. (24) The best product for you will ultimately depend on what’s causing your hair loss. 

What Hair Oils Can Help With Hair Loss?

Green tea oil and pumpkin seed oil are of particular interest in helping fight hair loss. Both of these oils can inhibit dihydrotestosterone (DHT), a hormone known to cause pattern baldness. Prescription hair loss products like finasteride and dutasteride use DHT inhibition to combat loss.

Rosemary oil is another product shown to help regrow hair. It promotes increased circulation, a bit like the FDA-approved hair loss treatment minoxidil. The human head has millions of tiny blood vessels which supply nutrients to hair follicles. By improving blood flow, rosemary oil helps more nutrients reach follicles, stimulating hair growth. (27)

What Hair Gels Can Help With Hair Loss?

Hair gels are essential when combating hair loss associated with heat and UV damage. Hair gels designed for heat and UV protection help seal hair against damage. These gels work by forming a physical barrier, protecting the hair shaft. Just like a chain is only as strong as its weakest link, your hair is only as strong as its weakest point.  (13,21)

Another interesting product used for hair loss is 5 percent garlic gel. Garlic is known to have antimicrobial properties. By normalizing the scalp micro-environment, garlic can help promote healthy hair growth and diminish loss. One study that used 5 percent garlic gel in combination with a prescription steroid (betamethasone cream 0.01 percent) helped to regrow hair in 19 out of the 20 patients studied. (24)

Can Hair Masks Help With Hair Loss?

Keratin is an important building block for hair growth. This protein is available in many products, including masks, sprays, and expensive salon treatments.

Before you invest in these products, you should know that commercially available keratin is derived from wool or chicken feathers. The animal keratin used in these products is less effective than human keratin at repairing damaged hair. (11)

Keratin products can help strengthen damaged hair strands, preventing breakage and hair fall. However, these topical preparations do not affect hair growth from the root and can’t help counteract androgenic alopecia or other types of hair loss.

Which Hair Cream, Gel, or Oil Should You Use For Hair Loss?

The most common form of hair loss is androgenic alopecia, commonly known as pattern baldness. This condition is linked to individual genetics and the production of a hormone called dihydrotestosterone (DHT).

Many hair loss products aim to block DHT to stop the progression of pattern hair loss. One product that has shown much promise is ketoconazole. This drug is a DHT blocker with antimicrobial and anti-inflammatory properties. It’s available as a shampoo, lotion, cream, and gel.

Microbial imbalance can cause increased scalp inflammation, leading to increased hair loss. Ketoconazole can decrease inflammation by normalizing the scalp microbiome. Since it acts in several different ways, this drug can treat multiple types of hair loss. (1)

Natural products, like pumpkin seed oil, have also shown DHT inhibition. This and other essential oils are often infused into hair oils and other topical preparations.

Essential oils can also help with inflammation-related hair loss. Inflammation is a known cause of cellular injury. Some essential oils with anti-inflammatory responses include:

  • Aloe Vera
  • Anise Star
  • Bergamot
  • Cinnamon Leaf
  • Eucalyptus
  • Juniperus Berry
  • Lavender
  • Thyme
  • Ylang-ylang
  • Salvia
  • Helichrysum
  • Chamomile
  • Wild ginger (like Alpinia pahangensis and Alpinia murdochii)

Many essential oils also have antimicrobial properties. Like ketoconazole, they can balance scalp microflora to counteract hair loss. Essential oils with antimicrobial properties include (23):

  • Thyme
  • Oregano
  • Garlic
  • Lemon Balm
  • Cinnamon
  • Lavender

Combination Treatments

Can You Use Ketoconazole and Minoxidil?

Minoxidil is an FDA-approved hair loss treatment that works as a vasodilator. It is possible to use both ketoconazole shampoo and minoxidil. But surprisingly, no large-scale, double-blind, placebo-controlled trials have combined just ketoconazole and minoxidil. Studies that tested both ketoconazole and minoxidil have assessed more complex combination treatments. (4,5) 

New research involving Nuh Hair (a lotion made of topical finasteride, dutasteride, and minoxidil) was recently published. Study participants — who all used NuH Hair lotion — were given the option of also taking 1-milligram finasteride pills daily, using 5 percent minoxidil foam daily, and using 2 percent ketoconazole shampoo 2 to 3 times a week. Participants who used all the suggested items saw hair growth in as little as 30 days. All men in the study saw hair growth within 3 months. (4)

Another study involving even more patients used a combination of dietary supplements, low-level light therapy, 2 percent ketoconazole shampoo, and 2 percent minoxidil, as well as 1 milligram of finasteride twice a week. Finasteride is meant to be taken daily, but in this study, participants took just one tablet every 3 days. Study results show increased hair count at 4 months. (5)

Can You Use Ketoconazole and Finasteride?

Oral finasteride and ketoconazole shampoo can both be used to combat hair loss. Both of these drugs are dihydrotestosterone (DHT) inhibitors. DHT is a hormone linked to the progression of pattern hair loss.

Oral finasteride is an oral prescription product. It’s been approved by the Food and Drug Administration and European Medicines Agency for androgenic alopecia. Ketoconazole is FDA-approved for fungal skin infections (specifically, tinea versicolor). It can help improve hair regrowth, especially when there is an underlying scalp condition like seborrheic dermatitis. (1,23)

New research combining ketoconazole shampoo and topical finasteride has also shown promise in treating pattern baldness. One study tested four groups of people, each receiving a different treatment for pattern baldness.

  • Group One: 1 milligram of oral finasteride daily.
  • Group Two: 1 milligram of oral finasteride daily and 2 percent minoxidil solution to be used twice a day.
  • Group Three: 2 percent minoxidil solution to be used twice a day.
  • Group Four: 1 milligram of oral finasteride daily plus 2 percent ketoconazole shampoo three times a week.

Effectiveness was measured based on patient self-assessment scores recording improvements in hair fall and hair growth. Participants in groups two and four achieved the best results. However, the combination was not significantly better than using finasteride alone. (45) 

 Safety and Side Effects

Can Shampoos Cause Side Effects?

Personal care products such as shampoo can cause side effects. Some side effects are attributed to chemicals that affect our hormones, particularly those associated with the endocrine system. The US Environmental Protection Agency (EPA) calls these chemicals endocrine-disruptors. (23) These endocrine-disrupting products can be present in both prescription and over-the-counter products.

Just because a product is listed as “all-natural” or contains natural oils does not mean it comes without risks associated with use. For example, lavender oil and tea tree oil have been associated with breast growth and premature menstruation. Both of these oils are classified as endocrine-disrupting chemicals. They have been noted to activate estrogen receptors and inhibit testosterone receptors. (23)

One of the most popular hair loss shampoos contains ketoconazole. Ketoconazole shampoo is very well tolerated and not associated with systemic side effects. Less than 1 percent of patients experience one or more of the following: (3)

  • Hair loss
  • Irritation
  • Change in hair texture
  • Scalp pustules
  • Itching
  • Burning
  • Contact dermatitis
  • Unspecified site reactions

Can Shampoo Cause Hair Loss?

Cleaning your hair is the primary function of any shampoo. Products achieve this by removing dirt and oil, which are natural to your body and the environment. However, this removal process is a delicate balance. The over-removal of natural oils (sebum) can lead to dryness and frizz, leading to breakage and hair loss.

Conditioners are frequently used to combat dryness and frizz. But insoluble silicones, which are common in hair care products, have been associated with scalp buildup. This product buildup can weigh hair down and lead to unhealthy scalp conditions. (31)

Unhealthy scalp conditions have been linked to hair loss in certain dermatological conditions such as seborrheic dermatitis, atopic dermatitis, and psoriasis. These conditions have been known to cause oxidative stress (the imbalance between free radicals and antioxidant defenses, leading to cellular damage), resulting in hair loss. (12)

Hair Products People Should Avoid

There is no one-size-fits-all approach to hair care products, but there are certainly ingredients you want to stay away from! Two synthetic hair care products — P-phenylenediamine (PPD) and phthalates ​​— have been linked to a laundry list of health complications. Both of these compounds have been classified as endocrine-disrupting chemicals. The US Environmental Protection Agency (EPA) calls these endocrine disruptors as they have been associated with hormonal imbalance both in adults and children.

PPDs are common in hair dyes (especially dark colors), but they can also be spotted on hair care product labels. Always try to choose a product that is PPD-free!

Phthalates are harder to spot on product labels. They are sometimes disguised in the ingredient list and labeled as a “fragrance.” Manufacturers are allowed to label these harmful products as a fragrance if they are 20 percent or less of the product composition. Phthalates have been associated with countless nerve and hormone issues, including human reproductive disorders. To avoid these harmful chemicals, it’s best to choose fragrance-free products! (32-36)


  1. Piérard-Franchimont, C., De Doncker, P., Cauwenbergh, G., & Piérard, G. E. (1998). Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology, 196(4), 474-477.
  2. El-Garf, A., Mohie, M., & Salah, E. (2019). Trichogenic effect of topical ketoconazole versus minoxidil 2% in female pattern hair loss: a clinical and trichoscopic evaluation. Biomedical Dermatology, 3(1), 1-8.
  3. American Society of Health-System Pharmacists, Inc. (2016, May 15) Ketoconazole Topical. Medline Plus.
  4. Rafi, A. W., & Katz, R. M. (2011). Pilot study of 15 patients receiving a new treatment regimen for androgenic alopecia: the effects of atopy on AGA. International Scholarly Research Notices, 2011.
  5. Rajput, R. J. (2010). Controversy: is there a role for adjuvants in the management of male pattern hair loss?. Journal of cutaneous and aesthetic surgery, 3(2), 82.
  6. Badri T, Nessel TA, Kumar D. (2021) Minoxidil. StatPearls [Internet].
  7. Choi, F. D., Juhasz, M. L., & Mesinkovska, N. A. (2019). Topical ketoconazole: a systematic review of current dermatological applications and future developments. Journal of Dermatological Treatment.
  8. Naldi, L. (2010). Seborrhoeic dermatitis. BMJ clinical evidence, 2010.
  9. Pierard‐Franchimont, C., Goffin, V., Henry, F., Uhoda, I., Braham, C., & Piérard, G. E. (2002). Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations. International journa
  10. Nizoral (ketoconazole) 2% shampoo description nizoral cis … NIZORAL® (KETOCONAZOLE) 2% SHAMPOO DESCRIPTION. (2013). Retrieved November 20, 2021, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019927s032lbl.pdf.
  11. Basit, A., Sadaf, S., & Akhtar, M. W. (2018). Health improvement of human hair and their reshaping using recombinant keratin K31. Biotechnology Reports, 20, e00288.
  12. Trüeb, R. M., Henry, J. P., Davis, M. G., & Schwartz, J. R. (2018). Scalp condition impacts hair growth and retention via oxidative stress. International journal of trichology, 10(6), 262.
  13. Ezekwe, N., King, M., & Hollinger, J. C. (2020). The use of natural ingredients in the treatment of alopecias with an emphasis on central centrifugal cicatricial alopecia: a systematic review. The Journal of Clinical and Aesthetic Dermatology, 13(8), 23.
  14. Nicolas-Morgantini, L. (2007). Giant micelles and shampoos. In Giant Micelles (pp. 493-514). CRC Press.
  15. Araújo, L. A. D., Addor, F., & Campos, P. M. B. G. M. (2016). Use of silicon for skin and hair care: an approach of chemical forms available and efficacy. Anais brasileiros de dermatologia, 91, 0331-0335.
  16. Pekmezci, E., Dündar, C., & Türkoğlu, M. (2018). A proprietary herbal extract against hair loss in androgenetic alopecia and telogen effluvium: a placebo-controlled, single-blind, clinical-instrumental study. Acta Dermatovenerol Alp Pannonica Adriat, 27(2
  17. Patel, D. P., Swink, S. M., & Castelo-Soccio, L. (2017). A review of the use of biotin for hair loss. Skin appendage disorders, 3(3), 166-169.
  18. Clarke, J., & Robbins, C. R. (1991). Influence of hair volume and texture on hair body. J. Soc. Cosmet. Chem, 42, 341-350.
  19. Dias, M. F. R. G., de Almeida, A. M., Cecato, P. M. R., Adriano, A. R., & Pichler, J. (2014). The shampoo pH can affect the hair: myth or reality?. International journal of trichology, 6(3), 95.
  20. Draelos, Z. D. (2010). Essentials of hair care often neglected: Hair cleansing. International journal of trichology, 2(1), 24.
  21. Mahajan, A. (2016). Advancements in polymers used in hair care: a review. Int J Res Cosmet Sci, 6, 6-16.
  22. Bussoletti, C., Mastropietro, F., Tolaini, M. V., & Celleno, L. (2010). Use of a caffeine shampoo for the treatment of male androgenetic alopecia. Journal of Applied Cosmetology, 28(4), 153.
  23. Ramsey, J. T., Shropshire, B. C., Nagy, T. R., Chambers, K. D., Li, Y., & Korach, K. S. (2020). Focus: Plant-based Medicine and Pharmacology: Essential Oils and Health. The Yale journal of biology and medicine, 93(2), 291.
  24. Hajheydari, Z., Jamshidi, M., Akbari, J., & Mohammadpour, R. (2007). Combination of topical garlic gel and betamethasone valerate cream in the treatment of localized alopecia areata: a double-blind randomized controlled study. Indian journal of dermatology, venereology and leprology, 73(1), 29.
  25. Moosavi, Z. B., Aliabdi, M., Golfakhrabadi, F., & Namjoyan, F. (2020). The comparison of therapeutic effect of Clobetasol propionate lotion and squill extract in alopecia areata: a randomized, double-blind clinical trial. Archives of dermatological resear
  26. Abd Elazim, N. E., Kamal, A., Abdel Gaber, R. M., Fathy, E., & EL‐Deek, H. E. (2021). Efficacy of topical calcipotriol betamethasone dipropionate as a new adjuvant therapy to follicular unit extraction technique in treatment of stable vitiligo: clinical,
  27. Ashique, S., Sandhu, N. K., Haque, S. N., & Koley, K. (2020). A Systemic Review on Topical Marketed Formulations, Natural Products, and Oral Supplements to Prevent Androgenic Alopecia: A Review. Natural Products and Bioprospecting, 1-21.
  28. Guo, E. L., & Katta, R. (2017). Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatology practical & conceptual, 7(1), 1.
  29. Lee, S. W., Juhasz, M., Mobasher, P., Ekelem, C., & Mesinkovska, N. A. (2018). A systematic review of topical finasteride in the treatment of androgenetic alopecia in men and women. Journal of drugs in dermatology: JDD, 17(4), 457.
  30. Vanó-Galván, S., & Camacho, F. (2017). Novedades terapéuticas en tricología. Actas Dermo-Sifiliográficas, 108(3), 221-228.
  31. Dias, M. F. R. G. (2019). Pro and contra of cleansing conditioners. Skin appendage disorders, 5(3), 131-134.
  32. Gago‐Dominguez, M., Castelao, J. E., Yuan, J. M., Yu, M. C., & Ross, R. K. (2001). Use of permanent hair dyes and bladder‐cancer risk. International journal of cancer, 91(4), 575-579.
  33. Wang, Y., Zhu, H., & Kannan, K. (2019). A review of biomonitoring of phthalate exposures. Toxics, 7(2), 21.
  34. Radke, E. G., Braun, J. M., Nachman, R. M., & Cooper, G. S. (2020). Phthalate exposure and neurodevelopment: A systematic review and meta-analysis of human epidemiological evidence. Environment international, 137, 105408.
  35. Radke, E. G., Braun, J. M., Meeker, J. D., & Cooper, G. S. (2018). Phthalate exposure and male reproductive outcomes: a systematic review of the human epidemiological evidence. Environment international, 121, 764-793.
  36. Food and Drug Administration (Food and Drug Administration (FDA)) (2013, December 15). Phthalates. U.S. Food and Drug Administration. 
  37. Hsu, C. L., Liu, J. S., Lin, A. C., Yang, C. H., Chung, W. H., & Wu, W. G. (2014). Minoxidil may suppress androgen receptor-related functions. Oncotarget, 5(8), 2187.
  38. Traish, A. M. (2020). Health risks associated with long-term finasteride and dutasteride use: it’s time to sound the alarm. The world journal of men’s health, 38(3), 323.
  39. Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug design, development and therapy, 13, 2777.
  40. Kaur, A., Singh, T. G., Dhiman, S., Arora, S., & Babbar, R. (2020). Novel herbs used in cosmetics for skin and hair care: A review. Plant Arch, 20(1), 3784-3793.
  41. Marks, D. H., Prasad, S., De Souza, B., Burns, L. J., & Senna, M. M. (2020). Topical antiandrogen therapies for androgenetic alopecia and acne vulgaris. American journal of clinical dermatology, 21(2), 245-254.
  42. Yaghmaee, R., Mirbagheri, M., Pakdaman, M. H., Rad, F., & Gharibi, F. (2016). The effect of minoxidil 1 shampoo on androgenetic alopecia: A clinical trial study. Research Journal of Pharmaceutical, Biological and Chemical Sciences, 7(5), 856-862.
  43. Shanshanwal, S. J., & Dhurat, R. S. (2017). Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: A randomized controlled open-label, evaluator-blinded study. Indian journal of dermatology, venereology and leprology, 83(1), 47-54
  44. Afiune, L., Ushirobira, C. Y., Barbosa, D., de Souza, P., Leles, M., Cunha-Filho, M., Gelfuso, G. M., Soler, M., & Gratieri, T. (2020). Novel iron oxide nanocarriers loading finasteride or dutasteride: Enhanced skin penetration for topical treatment of alopecia. International journal of pharmaceutics, 587, 119709.
  45. Khandpur, S., Suman, M., & Reddy, B. S. (2002). Comparative efficacy of various treatment regimens for androgenetic alopecia in men. The Journal of dermatology, 29(8), 489–498.
  46. Lourith, N., & Kanlayavattanakul, M. (2013). Hair loss and herbs for treatment. Journal of cosmetic dermatology, 12(3), 210-222.
  47. Fields, J. R., Vonu, P. M., Monir, R. L., & Schoch, J. J. (2020). Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review. Dermatologic therapy, 33(1), e13202.
  48. Phillips, T. G., Slomiany, W. P., & Allison, R. (2017). Hair loss: common causes and treatment. American family physician, 96(6), 371-378.
  49. Martinez-Jacobo, L., Villarreal-Villarreal, C. D., Ortiz-López, R., Ocampo-Candiani, J., & Rojas-Martínez, A. (2018). Genetic and molecular aspects of androgenetic alopecia. Indian journal of dermatology, venereology and leprology, 84(3), 263–268.
  50. Hyun, M.Y., Suk, J.M., Jung, S.W., Park, J.O., Kim, B.H., Jang, J.D., Joe, G.J., Yeo, I.K., Kim, B.J. and Kim, M.N., 2013. The Efficacy of Shampoo Containing Ginseng Radix on Preventing Hair Loss and Promotion Hair Growth. Journal of the Society of Cosmetic Scientists of Korea, 39(3), pp.187-194.
  51. Berger, R. S., Fu, J. L., Smiles, K. A., Turner, C. B., Schnell, B. M., Werchowski, K. M., & Lammers, K. M. (2003). The effects of minoxidil, 1% pyrithione zinc and a combination of both on hair density: a randomized controlled trial. British Journal of Dermatology, 149(2), 354-362.
  52. Ketoconazole 2% w/w Shampoo – Summary of Product Characteristics (SmPC) – (emc). (2021, May 12). Datapharm. Retrieved November 1, 2021.
  53. Newell, P., & Liszewski, W. (2021). Presence of Contact Allergens in Dry Shampoo Products. Dermatitis, 32(6), e129-e131.

Last updated July 2021