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Caffeine For Hair Loss (AGA): Evidence & Recommendations

Caffeine's role in hair loss (and hair growth) is hotly debated. On the one hand, oral caffeine may indirectly exacerbate hair loss in those who are hyperglycemic or hypothyroid. On the other hand, topical caffeine does have efficacy as a potential hair loss intervention – at least when combined with other ingredients like azelaic acid and minoxidil. Read on to learn the correct dilution ratios, and the details.

Written and reviewed by:
Rob English, Medical Editor

Caffeine & Hair Growth: A Scientific Deep-Dive

In recent years, there’s been an explosion of interest in caffeine shampoos / topicals and their potential to improve pattern hair loss (androgenic alopecia). The hope: that applying caffeine to our scalps might stimulate growth factors, improve blood flow, and maybe even reverse hair follicle miniaturization.

At first glance, caffeine use might look like a viable, natural intervention. But what does the research actually say?

In other words, does caffeine work? Is it a viable alternative to minoxidil? Is caffeine better if ingested, applied topically, or used as a shampoo? How much hair regrowth can we expect? And are there any longterm side effects?

This article dives in the science (and answers).

We’ll dispel a lot of common knowledge about caffeine’s efficacy for hair growth. We’ll also comb through the evidence, set realistic expectations, and reveal how to best use caffeine to maximize your chances of hair recovery.

Long-story short: caffeine isn’t a miracle cure. But it might not be completely useless, either.

Topical caffeine: highlights

  • Effort. Low – daily topical application, shampoo use, or ingestion are all easy to implement
  • Expectations. According to studies, hair improvements are typically observed by 6+ months
  • Response rate: 75%
  • Regrowth rate: 0-5%
  • Cost. $10-25 per month
  • Problems. Low-grade clinical evidence; studies measure outcomes like shedding rates and anagen:telogen ratios, not hair counts; lacking impressive before-after photosets; likely less effective than minoxidil; must be combined with other treatments or ingredients like azaleic acid for maximized benefit.

Key takeaways

Topical caffeine is clinically shown to reduce hair shedding rates and improve anagen:telogen ratios in men with androgenic alopecia. Unfortunately, it’s still unclear just how effective caffeine-based topicals and shampoos are for improving pattern hair loss.

Caffeine shampoos/topicals fall under an intervention umbrella of “low risk, low reward”. In other words, caffeine’s risk of significant side effects is minimal, as is the amount of hair growth it may initiate.

Having said that, not all caffeine is created equally. While topical caffeine products have been shown to improve shedding rates and anagen:telogen ratios, oral caffeine might actually increase hair loss in those who have insulin resistance or are hypothyroid.

Of all clinical studies on topical caffeine for pattern hair loss, the best results seem to occur when topical caffeine is combined with ingredients like azelaic acid or drugs like minoxidil.

In any case, a 0.2% caffeine dilution for topical solutions and a 1% caffeine dilution for shampoo formulations seem to be the best studied (and most promising), so look for brands that meet these criteria.

If you’re going to use caffeine as a potential hair loss intervention, please understand that this stimulant is only clinically tested on androgenic alopecia, and that it’s likely not effective as a standalone treatment.

More information on the science behind caffeine – its mechanisms, as well as the optimal delivery methods, dilution, and more for hair recovery – can be found below.

What is caffeine?

Caffeine is a stimulant derived from plants – namely, coffee and tea. It’s the most popular stimulant on the planet.

Caffeine structure

As a stimulant, caffeine has a variety of effects on the human body – from better focus to improvements in endurance. But interestingly, the magnitude of these effect often vary per person, and as a result of differences in our genetic constitution, food consumption, and even past caffeine exposure.

What popularized caffeine as a potential hair loss treatment?

In general, caffeine has been studied for its effects on:

  • The cardiovascular system – i.e., increased heart rate and possible vasodilation and/or vasoconstriction
  • Longevity – i.e., muscular development, cellular metabolism
  • Hormones – i.e., cortisol and thyroid hormones (these may play a role in caffeine’s “energizing” effects)

And interestingly, vasodilation, cellular metabolism, cortisol, and thyroid hormones have all been studied as potential treatments to different hair loss disorders.

For instance, hair loss drugs like minoxidil improve hair growth by increasing vasodilation; thyroid drugs like levothyroxine help to improve hypothyroid-related hair loss by restoring thyroid functionality.

This begs the question: what sort of impact might caffeine have on our hair follicles?

Can caffeine – ingested orally or applied topically – mimic the mechanisms of hair loss interventions? And if so, are the effects of caffeine strong enough to actually improve hair loss outcomes?

These connective points are what prompted scientists to start studying caffeine as a potential hair loss intervention. And taking a deeper look, there is some mechanistic overlap in how this stimulant might improve hair loss outcomes.

Caffeine is one of the most popular stimulants. It’s well-studied in terms of its effects on vasodilation, cellular metabolism, and hormonal health. And interestingly, these research avenues have left scientists wondering if caffeine can also be reoriented as a hair loss solution.

How might caffeine help with hair regrowth?

It’s hard to say. On the one hand, caffeine does have some hair-promoting effects. On the other hand, caffeine also has some issues that may actually contribute to hair loss. All in all, the way it will effect you will boil down to (1) the dose and (2) the ingestion type (oral or topical), and (3) your genetic constitution.

Here are a few effects that caffeine has – both positive and negative – in regard to hair health.

1. Topical caffeine may improve vasodilation (good)

Caffeine’s effects on blood flow vary depending on the mode of ingestion (i.e., topical versus oral) and the actual tissue being measured. Just see this chart demonstrating how oral caffeine impacts blood flow across body tissues.

Caffeine’s location-dependent effects on blood flow

(source)

Interestingly, both topical caffeine and oral caffeine seem to improve blood flow in microcapillary networks – the blood vessel networks that supply our peripheral tissues (i.e., skin) – and the same blood vessel networks that help support the growth of our hair follicles.

This is because in vascular smooth muscle cells, caffeine acts as a phosphodiesterase inhibitor. In other words, caffeine helps to block the enzyme phosphodiesterase.

This enzyme helps inactivate a molecule called cyclic adenosine monophosphate – a biological messenger molecule that regulates vasolidation (i.e., blood flow) in smooth muscle cells. In the absence of phosphodiesterase, more cyclic adenosine monophosphate accumulates, thus expanding vasodilation in smooth muscle tissues.

This is also why phosphodiesterase inhibitors are often prescribed for a variety of blood flow-related health conditions – i.e., erectile dysfunction, hypertension, and even vascular disease. They all help promote blood flow.

Caffeine happens to be one of these phosphodiesterase inhibitors. And while it’s a weak inhibitor, it still has an effect on these capillary networks.

But, there’s one caveat here. While it’s true that a defining characteristic of androgenic alopecia (AGA) is reduced blood flow, it’s still debated whether blood flow is a cause or consequence to hair follicle miniaturization. So, we don’t yet know if caffeine’s vasodilation effects will really have any impact to our hair.

2. Caffeine may increase cellular metabolism (good)

Caffeine doesn’t just inhibit phosphodiesterase. It also inhibits adenosine receptors – a type of neural receptor that helps to regulate cellular metabolism and our own sense of “wakefulness”.

In the absence of caffeine, a molecule called adenosine normally binds to an adenosine receptor in our brain. When adenosine binds to an adenosine receptor, our brain’s neural activity begins to quiet. The end-result: we feel a bit sleepier.

Caffeine is an adenosine receptor antagonist. That means that when it’s ingested, caffeine blocks adenosine receptors so that adenosine cannot bind to them. This prevents the “quieting” of neural activity – and thus promotes longer periods of wakefulness.

Interestingly, there’s also evidence that caffeine’s inhibition of both phosphodiesterase and adenosine receptors may promote cellular metabolism. To put it more bluntly, caffeine ingestion might help to improve (1) energy utilization in the body, and (2) the mobilization of free fatty acids for energy usage.

This may have pro-hair effects, as many genes that are upregulating in balding scalp tissues tend to have an association with impaired cellular metabolism. But again, we just don’t know for sure.

3. High-dose oral caffeine may increase insulin resistance (bad)

Unfortunately, not all effects from caffeine are pro-hair. While improving cellular metabolism may help support the growth stage of our hair follicles, there are also consequences to the way in which caffeine improves cellular metabolism that may negatively impact our hair.

For instance, one study found that oral caffeine consumption decreased insulin sensitivity by 15% in healthy adults. That’s not good – especially for young men and women who are balding, as insulin resistance is almost always a commonly confounding factor in early-onset AGA.

Moreover, there’s also evidence that at high dosages, oral caffeine’s “liberation” of free fatty acids also promotes hyperglycemia and insulin resistance in peripheral tissues (i.e., our skin) – possibly as a result of increased stress hormones like cortisol. Which brings us to our second concern…

4. Oral caffeine increases cortisol levels, and may impair thyroid function and skin quality.

Evidence strongly implicates oral caffeine consumption and an increase in cortisol levels. Unfortunately, the hormone cortisol, when chronically elevated, can negatively impact hair-related bodily functions and in two major ways:

Another noteworthy mention is that coffee can also impair the absorption of thyroxine. So, if you are taking this medication for a thyroid disorder, it’s likely in your best interest to avoid consuming coffee around the same time. But, it’s unclear whether this effect is a result of the caffeine content or other compounds found in coffee.

Again, we don’t yet have any data correlating oral caffeine consumption to pattern hair loss. But these concerns are worth noting for anyone who’s balding and has had a history of hyperglycemia, insulin resistance, hypothyroidism, or adrenal dysregulation.

What about topical caffeine?

In contrast to high dose oral caffeine, it doesn’t seem like topical caffeine elicits the exact same anti-hair effects. Rather, topical caffeine (as a lotion or shampoo) might have some therapeutic benefit to our scalp hair.

For reference, in vitro studies in humans and in vivo studies in mice suggest that caffeine’s effects on (1) phosphodiesterase inhibition and (2) adenosine receptor binding probably will improve hair growth, and through a variety of means.

Specifically, topical caffeine might

  • Prolong the growth phase of the hair cycle (i.e., the anagen phase)
  • Stimulate matrix keratinocyte proliferation – or encourage the growth of new hair fibers
  • Increase IGF-1 – a signaling protein that helps regulate hair growth
  • Inhibit apoptosis – or the “death” of cells responsible for regulating hair growth
  • Promote blood flow – which is historically much lower in balding versus non-balding scalps

So, overall, it seems like mechanistic evidence supports at least the use of topical caffeine as a potential hair loss intervention. And this conclusion is why so many researchers have bothered studying caffeine lotions and shampoos for the improvement of AGA.

Caffeine is a (1) phosphodiesterase inhibitor and (2) an adenosine receptor antagonist. While its effects vary on a tissue-by-tissue basis, oral and topical caffeine seem to improve microcapillary networks in periphery tissues (where our hair follicles reside). Moreover, caffeine can help improve cellular metabolism by liberating free fatty acids for energy use. Improvements to both (1) vasodilation and (2) cellular metabolism should theoretically benefit our hair.

At the same time, oral caffeine seems to also increase insulin resistance in peripheral tissues. This is problematic – as reduced insulin sensitivity may interfere with the growth cycles of our hair follicles. Moreover, oral caffeine consumption can increase cortisol levels and decrease thyroid functionality – which may also negatively impact hair growth cycles.

Despite concerns of oral caffeine use for hair, evidence does support the use of topical caffeine for hair growth – at least from a mechanistic standpoint. In vitro research suggests that, in human hair follicles, topical caffeine helps to prolong anagen duration, increase IGF-1, inhibit cell death, and improve blood flow. While this doesn’t mean that these effects will translate in vivo, it does give credence to the idea that topical caffeine is worth testing as a hair loss intervention.

This all brings us to our next question: what does the clinical data say about topical caffeine and its use as a hair growth stimulant?

Is topical caffeine effective for hair loss?

This is harder to answer than it may seem.

At face-value, the answer is yes. This is because there are a lot of studies showing that caffeine in a topical or shampoo (or caffeine in conjunction with minoxidil and/or azelaic acid) can improve hair loss outcomes.

For instance, this recent literature review on topical caffeine dives into over a dozen clinical studies, many of which report:

  • “…Statistically significantly better results” when used in conjunction with minoxidil versus minoxidil alone
  • Higher patient satisfaction when used with minoxidil compared to minoxidil alone
  • Decrease in hair loss after washing when using caffeine + minoxidil + azelaic acid, with similar results to a minoxidil solution after 36 weeks
  • Decrease in hairs lost in a hair pull test after 6 months of using a caffeine shampoo (no placebo) and 4 months of using a caffeine-containing lotion.

Reading these conclusions, it’s no wonder why caffeine topical sales have spiked in the last few years.

However, taking a closer look, these studies might not be as encouraging as their conclusions imply. Here’s why.

Quality analysis: how do caffeine-hair loss studies stack up?

When it comes to research, not all peer-reviewed papers are created equally.

Some studies are published in predatory journals that circumvent the peer review process; others are published in low-ranking journals; others simply have major methodological concerns that draw the findings of those studies into question.

When it comes to the studies on caffeine and hair regrowth, it’s that last issue that’s most prevalent. That’s not to say that we should dismiss caffeine’s effects entirely. But, there are several concerns worth highlighting.

1. Methodological concerns

In the above literature review, most of the feature studies don’t measure hair count increases. Rather, they measure endpoints like patient self-satisfaction surveys, changes to anagen:telogen ratios, and a reduction in hair fall during “wash tests” or “tug tests”.

These measurements are difficult to standardize and are notoriously unreliable, meaning it can be hard to determine the true effectiveness of caffeine from any study designed this way.

In fact, it’s my belief that a lot of industry-funded research purposefully chooses these measurement endpoints because of their unreliability. For reference, these types of endpoints are why so many low-level laser therapy studies will report almost unbelievable hair improvement – i.e., “200% hair diameter increases” or “80% hair density improvements” in their clinical trials – while paradoxically, having no visual improvements to show subjects’ photographic assessments.

The bottom line: these measurement endpoints aren’t very strong, and some investigators who choose these endpoints may be doing so to deliberately skew caffeine’s perception of efficacy. But no matter what, the weaker the hair measurement endpoints, the less reliable the results.

2. Topical caffeine is rarely measured as a standalone treatment

Most of these studies measure topical caffeine alongside enhancer ingredients – like azelaic acid, minoxidil, or both – and not caffeine as a standalone treatment. This makes it hard to evaluate whether caffeine by itself is very effective.

In fact, there’s just one study that we could find that measured topical caffeine as a standalone treatment. Unfortunately, it measures topical caffeine versus minoxidil, not a placebo. That study’s takeaway? That topical caffeine is similarly effective to 5% minoxidil… at least when we compare weak measurement endpoints (see #1).

3. Conflicts of interest

Of all the clinical research done on caffeine and hair growth, most of it is industry-funded.

At face-value, this isn’t necessarily a problem. After all, a significant portion of hair loss studies comes from industry-funded research teams. Where there’s financial incentive for a treatment, there will be attempts at peer-reviewed research to prove efficacy.

Having said that, this does become a problem when the studies are typically designed with poor measurement outcomes – such that the odds of achieving “favorable” results increases dramatically. Nearly all of the topical caffeine studies on AGA have this very problem. Compile that with the issue of almost never measuring caffeine alone, and you have even more problems (see #1 and #2).

4. Manufacturers publish research on topical caffeine, but sell you shampoo-based caffeine

One of the most frustrating aspects of hair loss products are that manufacturers will publish a study showing their product demonstrating benefit, but then sell you a product that’s different from the one studied.

This happens all the time with LLLT devices, and it seemingly also happens with caffeine products for hair loss.

Case in point: Alpecin’s study on a topical caffeine solution. The findings showed that this topical did improve hair loss outcomes. But ironically, Alpecin doesn’t sell this topical; it sells a caffeine shampoo. Topicals are leave-in for hours, whereas shampoos may only come into contact with the scalp for 60 seconds. It was this issue in addition to #1-#3 that got Alpecin banned in certain countries from saying their “shampoos” could reduce hair loss.

It was a combination of these issues that led researchers in the above literature review to conclude that while caffeine might help improve aspects of our hair, there isn’t yet enough evidence to support most claims being made by manufacturers.

Topical caffeine does have clinical research supporting its use for hair loss. However, in literature reviews of the dozen or so studies on topical caffeine, concerns of endpoint measurements, lacking study as a standalone treatment, conflicts of interest, and discrepancies in what’s studied versus sold to consumers raises red flags as to caffeine being a truly viable long-term solution.

Despite all of this, there is evidence that topical caffeine might help our hair

Circling back to that literature review, there is accumulating evidence that caffeine can help reduce hair shedding from androgenic alopecia and even improve anagen:telogen ratios. It’s just that if we’re going to use it, we shouldn’t set our expectations at regrowth; we should set our expectations at a slowing of hair loss.

This leaves us with an interesting dilemma: if we want to leverage caffeine as a hair growth promoter, we need to do so in topical or shampoo form. And that means we need to know:

  1. What’s the best caffeine formulation: topical or shampoo?
  2. Is there a difference in regrowth reported between 0.2% and 1% caffeine dilutions?
  3. What’s the optimal frequency of application? Once a week, once a day, etc.?
  4. Does the effectiveness of caffeine wane over time – like minoxidil and other hair loss drugs?

Sifting through the literature review, there are studies that answer these questions. But again, they’re all subject to significant bias.

Even still, we can use these studies to guide some caffeine best practices – at least for those who want to make the investment and try it out.

Using caffeine for hair growth: best practices

The best caffeine formulation is likely within a shampoo or topical

Oral caffeine likely doesn’t accumulate in the scalp at a high enough degree to elicit adverse or beneficial effects. However, it may have peripheral action through increased cortisol levels, and this may indirectly impede hair growth for those with insulin resistance and/or hypothyroidism.

Knowing this, the safest and most effective way to use caffeine for hair growth is through topical means, either through some sort of lotion or shampoo.

Considering one study found that caffeine solutions penetrate the hair follicle after 2 minutes and peak at 2 hours, a leave-on caffeine solution may be optimal over a shampoo formulation.

The best caffeine dilution is 0.2% for topicals and 1% for shampoos (as far as we can tell)

But to be clear: the answer likely depends on whatever other ingredients are also in the topical (i.e., azelaic acid, minoxidil, etc.). Here’s why.

  • This study, the only study measuring the efficacy of caffeine alone, found that a 0.2% caffeine topical (Alpecin) was just as effective as 5% minoxidil at improving anagen hair percentages.
    • Problems: does not measure total hair count changes, thus improvements to anagen:telogen ratio can also be achieved by simply just shedding more telogen hairs for either treatment group; study only went for 6 months and results (i.e., improvements to anagen:telogen ratio for both caffeine topical and minoxidil) are within range for what we’d expect from seasonality
  • Pazoki-Toroudi et al. (2013) assessed the combination of caffeine 1%, minoxidil 5%, and azelaic acid 1.5% versus minoxidil 5%. The combination therapy was more effective than minoxidil alone.
    • Problems: does not measure caffeine alone, so we can’t really say.
  • Bussoletti et al. (2010, 2011) found that a 1% caffeine shampoo alone and caffeine lotion alone both resulted in less hair lost to a pull test after 6 and 4 months, respectively.
    • Problems: no concentration specified for the lotion; no control group used to assess true efficacy.
  • Golpur et al. (2013) found that caffeine + 2.5% minoxidil was more effective than 2.5% minoxidil alone.
    • Problems: no percentage of caffeine was indicated.
  • Sisto et al. (2013) analyzed the effects of a caffeine-containing shampoo vs a caffeine-free shampoo and found that the active treatment was superior to the placebo.
    • Problems: no concentration specified.

So, from what we can garner from the limited studies available, a 0.2% solution for topical application seems to be somewhat effective. However, keep in mind that this is only for a leave-on treatment, not a shampoo.

We don’t really have much information on optimal shampoo dilution. A 1% dilution was the only concentration reported for caffeine shampoo alone, but this treatment wasn’t compared against a placebo and, so, results aren’t super applicable. Even still, 1% seems to be comparably effective to minoxidil.

A 1% caffeine, minoxidil 5%, and 1.5% azelaic acid shampoo was considered more effective than minoxidil alone, but we can’t extrapolate this 1% dilution to a caffeine-only shampoo.

0.2% for topical solutions and 1% for shampoo formulations is all we can really extract from the current body of evidence, but it should be noted that these recommendations aren’t necessarily reliable given the minimal evidence.

What is the optimal frequency of use?

Like concentration, data on the frequency of use is also sparse. In the highest quality study, subjects used a 0.2% caffeine topical twice a day, every day. Another study instructed subjects to apply a caffeine lotion (unspecified concentration) once daily.

Other studies likely using shampoos most likely involved subjects using the treatment product however often they would normally shampoo their hair. So, it can be difficult to quantify just how often is optimal because use wasn’t standardized, as far as we can see.

With the knowledge we have, daily use of a topical seems to be optimal. Conversely, using a shampoo daily may be drying to the hair and the scalp, so it’s safe to say that using a caffeine-containing shampoo however often you would normally shampoo is probably best.

Does caffeine’s efficacy wane over time?

While no studies measure caffeine’s effectiveness for long enough to see if regrowth is sustained, we can assume – like nearly all topicals – that its hair-promoting effects will likely lessen over time.

The reasons why will be explained in a future article – one comparing the long-term outcomes of antiandrogenic versus non-antiandrogenic hair loss interventions. But the short answer is that we can liken any sort of topical formulation for hair loss – even minoxidil – as a bandaid that won’t necessarily fully address the underlying roots of the problem.

Summary

Topical caffeine may help to elongate the anagen phase of the hair cycle, improve anagen:telogen ratios, decrease hair shedding, and slow the progression of androgenic alopecia (AGA). But it’s by no means a miracle cure, and evidence so far suggests that this topical isn’t any better than 5% minoxidil.

The limited evidence we do have on topical caffeine is relatively biased, poorly designed, and has only been studied for androgenic alopecia. Until studies with better designs are published, it’s hard to say with certainty just how much of an effect topical caffeine will have on our hair.

Nevertheless, topical caffeine leave-on treatments have more quality evidence to support their use (as opposed to shampoos). 0.2% dilutions for topicals and 1% dilutions for shampoos seem to be the most promising. Moreover, the best way to utilize caffeine seems to be in conjunction with minoxidil and, possibly, azelaic acid.

Paradoxically, oral caffeine consumption may have an adverse effect on hair growth through increased cortisol release, increased hyperglycemia in periphery tissues, and potentially decreased thyroid functionality. For these reasons, anyone with a history of insulin resistance or hypothyroidism is probably better off avoiding oral caffeine altogether – particularly for hair health.

If you do decide to implement caffeine into your regrowth regimen, the first thing you’ll notice is how difficult it is to field the market. Almost all companies that have any merit in this space don’t quantify the caffeine dilution in their products. Considering most caffeine treatments are upwards of $35 USD, you may want to call around and see if their customer service representatives can give you more information.

Let us know if you have personal experience or testament in using (or excluding) caffeine. If you start using caffeine, report your progress here for others to see! Any questions or comments? Please reach out in the comments section.

28 thoughts on “Caffeine For Hair Loss (AGA): Evidence & Recommendations”

    • Thanks Alex! I haven’t. I’ll check out these studies in more detail and get back to you with anything worth reporting.

      In general, the calcification observed in AGA resides deeper in the skin tissues – right above/within the skull bones and emissary veins that run through them and indirectly support the tissues residing below the galea aponeurotica. So, I’m not totally sure that a topical that improves soft tissue calcification would have a major impact on the case of AGA. But then again, this research in AGA is so underserved that there’s really no way to know for sure without a clinical study.

      Best,
      Rob

      Reply
  1. Hey Rob, I feel that my type of hair and hair loss is pretty similar to yours per what I see on your pictures. I can see my scalp in the crown area like in your picture from 2011, after that I feel that I have diffuse thinning throughout all my top area except for back an sides. When you started having hair loss did you also had difuse thinning on the rest of the top area? Also, when you started your massages, did you just focus on the crown or all the scalp? Also I was diagnosed with dandruff a long time ago and haven’t fully got red of it since my scalp is a little bit itchy most of the time, do you think that dandruff may also cause hair loss? By the way my dad and uncles all have full head of hair. Thanks!

    Reply
    • Hey Ed,

      Thanks for reaching out. I noticed diffuse thinning throughout the entire top of my scalp, with most of it being focused on the crown. As far as massaging – I made an effort to massage everywhere: the vertex, frontal regions, and scalp perimeter (i.e., scalp sides). There’s evidence that the acute inflammation generated in thinning regions from massages may act like a small microneedling / PRP session, and that massaging the scalp perimeter might help relax chronically tensed muscles that impede blood flow to thinning regions. So, different mechanisms, different benefits. Here’s an article that you might find interesting:

      https://perfecthairhealth.com/scalp-massages-androgenic-alopecia-study/

      Moreover, there’s also a hypothetical argument to be made that hair follicle stem cell migration to balding sites may improve from wounding non-thinning regions nearby thinning regions. But that’s for another article.

      As far as dandruff – this is commonly associated with AGA. It might be a symptom of (1) AGA-related inflammation, (2) a p. acnes / malassezia infection, (3) a symptom of massaging too hard, or (4) all of the above. Generally, you’d want to troubleshoot the causes methodologically: for example, (1) trying 2% ketoconazole shampoo, and/or (2) reduce your massage intensity. Usually one of those things will greatly improve dandruff. However, given that your dandruff is long-standing and predates massaging, my bet is on causes (1) and (2).

      Best,
      Rob

      Reply
      • Hi Rob,
        Thanks for your reply. I’m curious on the treatment that you used to recover your hair, besides the massages and diet have you also used dermarroler or any other tropicals after you fully quit minoxidil? What do you think of onion juice and honey, do you think it may also help? I have started applying that and also drinking a lot of water, I have a feeling that my situation is not AGA related though as my family have good hair, I have also done a tyrod test with normal results. Any thoughts?
        Thanks!!

      • Hey Ed,

        When I quit minoxidil, LLLT, and supplements / topicals – I transitioned exclusively to massaging and ended up seeing cosmetically significant results within 10-12 months. I continued with the massages for years thereafter, sometimes incorporating stints of 3-month microneedling sessions. These seemed to improve results a bit more, albeit more so personally than cosmetically. I’d estimate that most of my improvements plateaued at the two-year mark.

        As far as adding in topicals – you can certainly try this, though there aren’t yet any “best practices” for which topicals / combinations are the most effective (especially when just considering natural topicals). Onion juice and honey might help, but what seems to have clinical efficacy are topicals that help to reduce type II 5-alpha reductase. In the natural sphere, that’s likely saw palmetto, pumpkin seed oil, green tea extract, (maybe) caffeine, etc.

        There are a variety of hair shedding disorders that can mask themselves as AGA but actually aren’t that condition. Hypothyroidism is just one of these. If you’d like to learn a bit more, this is briefly discussed in this article:

        https://perfecthairhealth.com/scalp-massages-androgenic-alopecia-study/

        Best,
        Rob

    • Thanks Jasper! I’ll check this out. I also saw your other comment on the scalp tension article as well. It’s interesting to think about all of the indirect ways by which tension can be transmitted to the galea. Whether or not they have any merit in AGA progression – we just don’t know (yet). But a few other research teams seem to be hypothesizing some sort of interaction between the galea and AGA-prone hair follicles. This paper is particularly interesting if you have access to it:

      https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13379

      Best,
      Rob

      Reply
  2. Hi Rob! Excellent work. I have a quiestion because of MInoxidil is giving me some bad sides. I ve been a minoxidil user for several years, in conjuction with finasteride, on and off, without any problem, it was on my mid 20s to late 20s. Now in my late 30s, i cant tolerate it anymore, even at a minimun dose, it just turn off my libido, just a few drops of minoxidil and it turn off my libido for several weeks, it is just annoying…, same with finasteride. Cheers!

    Reply
    • Hey Paul,

      Thanks for the kind words. Regarding your questions – that’s very interesting. In my 5+ years writing about hair loss, only one other person has reached out to me to report sexual side effects from minoxidil (lowered libido). So, it seems like you’re in rare company!

      There is some evidence that minoxidil might bind to androgen receptors and thereby reduce testosterone and DHT from binding to cell sites. Technically, if this effect occurred elsewhere in the body, and at a significant enough magnitude, then it’s theoretically plausible that minoxidil might contribute to some sexual dysfunction as an androgen receptor antagonist. But these are big stretches in the literature, and I’d exercise caution when extrapolating the research that far.

      Do you notice the same effects when trying herbal-based DHT reducers (like saw palmetto) – topically and/or orally?

      Best,
      Rob

      Reply
  3. Thank you very much for your prompt response Rob, fortunately I am doing quite well with rosemary oil diluted in coconut oil, It has also been a year since I implemented your massage ideas together with no poo quite successfully. What is striking in my case are the negative effects of low doses of both minoxidil or finasteride, taking into account that I have used them without inconvenience for several years, my fear is that my androgen receptors in tissues have been increased. Thank you in advance for all your effort and congratulations on your excellent work.

    Reply
  4. Hi Rob,

    A lot of people have success with zix (zinc + vitamine B6) atleast for maintenance. There’s a big thread about this on hairlosstalk.com, could you investigate and may I suggest an article about this still unknown treatment?

    Love your articles, it all makes sense.

    Greetings,

    Ken

    Reply
  5. Actually caffeine really works. I have now on my 3month caffeine and the result is great. For the 1st week , i saw the difference of my hair shedding decreased from 60 to 10! Its true. I used also dermaroller but it could not do more things in decreasing hair shedd unlike caffeine almost works with miraculous way.believe me. I tried many topical lotion but caffeine does great than them

    Reply
  6. And also in my experience, u can use caffeine without dermaroller because it has amazing thing to penetrate the skin. It can absorb through the skin. I believe now the study about caffeine when i tried it and worked. Anyway i use black coffee as a caffeine topical lotion. Hope this help you guys

    Reply
  7. Hey howdy Rob, excellent article as Always!
    Hey what do you think about using a theragun or similar got scalp massage?
    I have neck probs so massage causes a fair amount of neck pain.
    I thought this might be good for well, pretty much scalp tissue, fibrosis, calcification break up, circulation etc.
    I don’t know if those kinds of vibs would do something weird to your brain though haha.
    Love to hear your thoughts though 🙂

    Reply
    • Hey Jasper,

      Thanks for your comment! There are a few people in our membership using a Theragun for the scalp – all of whom are reporting much better elasticity with shorter massage sessions. At least one has claimed shedding has reduced dramatically. But these members are just a few months into testing, so it’s a bit early to see how things pan out long-term.

      In general, I have concerns using any percussive instrument / massager on the scalp – as there’s a risk of brain rattling if the procedures aren’t done correctly. So I don’t plan on testing this myself. But others seem to enjoy it and say they don’t experience this!

      Best,
      Rob

      Reply
  8. Hello, Rob. First of all, I am grateful for your answers, articles, help and research. I’m a 21-year-old man with no aggressive shedding. For 6 years the temples are v-shaped and fixed. But last year, after using a chemical hair care product, hair loss became very severe. Do you think my condition is Androgenetic Alopecia or damage to the hair follicles? Finally, what can I do except massage to gain the old intensity?

    Reply
    • Hey Hasan,

      Thanks for your questions. It’s possible for chemical products to catalyze and/or accelerate androgenic alopecia, so that might’ve been the case for you. At the same time, AGA can go through its own periods of acceleration or acquiescence with no discernible triggers aside from higher androgen activity post-puberty.

      There are a lot of things you can do to improve your thinning, but all options depend entirely on you getting the proper diagnosis to confirm your type of hair loss. Once you have that, the right options depend on your age, gender, hair loss severity, comfortabilities with drugs, time availability, and finances. While I can’t adequately summarize your options in an article comment, I’m happy to talk more over a Skype call (these are part of our membership).

      Best,
      Rob

      Reply
  9. Hey Rob !

    Sorry if my request seems inappropriate, but could you create an article about the relationship between hairloss and masturbation ?

    Actually, a chinese company and the big pharma company Bayer are developping a hair loss drug that targets the prolactin receptor. After male orgasm, the prolactin levels become important in the system.

    Just wanted to know your opinion on this, please.

    Thanks in advance !

    Kev

    Reply
    • Hey Kev,

      I don’t think it has much of an impact until masturbation frequency reaches high extremes (eg: many ejaculations per day, and for years).

      The basic principle behind the hair loss-masturbation connection is that masturbation increases serum (blood) levels of prolactin, which can increase 5-alpha reductase (5-AR) in certain tissues (though where exactly is still up for debate), and therefore encourage the conversion of free testosterone to tissue DHT in the scalp. We know that elevated scalp tissue DHT is associated with hair loss.

      In any case, I don’t totally buy the masturbation-hair loss connection. For one – at least with the studies we have – it feels like the evidence is grasping at straws. Masturbation increases serum prolactin, and spikes in serum prolactin increase the enzyme 5-AR in certain tissues. But to be clear, 5-AR is found in tissues all over the body. 5-AR isn’t just unique to balding scalps. So while prolactin might increase 5-AR in body tissues, I haven’t yet seen a study that links masturbation-induced prolactin spikes to increased 5-AR in the scalp, and disproportionately versus other tissues.

      There are also buddhist monks who abstain from masturbation most of their adult lives and still lose their hair. So chronically elevated serum prolactin levels driven solely by masturbation probably aren’t a main driver of hair loss.

      What this tells me that is that if masturbation does contribute to pattern hair loss, it’s not a primary driver. It is possible that frequent masturbation might chronically increase cortisol levels and thereby suppress the thyroid. Elevated serum prolactin is associated with hair shedding in some animal models, so it’s possible that really frequent masturbation can raise prolactin enough to lead to hair shedding. But hair shedding disorders and pattern hair loss (AGA) are different, and we have to be careful not to group them into the same category.

      I hope this helps!

      Reply
    • As far as I’m concerned, your website, Rob, is one of the most reliable hair information communities. Your articles are my first resort when researching hair topics. Everything is evidence-based and unbiased.

      I’m considering a topical that contains some good ingredients, like caffeine, saw palmetto, ginkgo pilopa and green tea. But, following water, the second and third ingredients in the list are propylene glycol and PEG-40 hydrogenated castor oil. As for the former, can it irritate the scalp or be a cause of concern? Does it enhance the other ingredients penetration to the point that they reach the blood and consequently cause systemic side effects?

      I read that PEG-40 hydrogenated castor oil is too large to penetrate the skin and forms a film on the surface. So can it “clog” the scalp pores or something?

      Thanks, Rob.

      Reply
      • Hey Mahmoud,

        Thanks for the kind words! To answer your question – propylene glycol can sometimes irritate the scalp skin of certain individuals. In fact, propylene glycol is one of the most commonly used carrier agents for minoxidil, which can cause skin irritation in 2-7% of people. But interestingly, one study found that up to 80% of topical minoxidil’s side effects didn’t come from the minoxidil itself, but rather, the propylene glycol – and that by switching to a different carrier agent, these side effects dissipated.

        As far as systemic absorption, this is a possibility with any homemade topical. To maximize skin penetration while minimizing systemic absorption, you really need something that is formulated with chitosans, liposomes, or even cyclodextrins. That requires equipment that isn’t really available to consumers for home use.

        It’s also worth mentioning that PEG-40 hydrogenated castor oil is both propylene glycol + castor oil. It is a common ingredient in cosmetics and has great skin penetrative properties (to my knowledge). For the overwhelming majority of people, propylene glycol isn’t problematic. So I’d give it a go and see how things work out! If you end up with skin irritation, there are dozens of other carrier agents from which to choose.

        Best,
        Rob

  10. Hi Rob,

    Thank you for sharing all your articles and info on your website! It’s been very educational going through them.

    I read that topical caffeine can make minoxidil less effective, since it inhibits adenosine receptors. Seems like if I want to use both, it would be better applying them at different times as to not cause conflicts. If that’s the case, I wonder why there are formulations out there that include both in the same solution.

    I’ve only recently become interested in hair regrowth – bought 2 bottles of generic brand minoxidil at first, then been reading up on all sorts of other topicals/treatments people use and started incorporating them. After reading your articles I’m probably going to stop minoxidil after finishing what I’ve got, and focus more on massage and dermarolling. This is my current regimen:

    Morning:
    Minoxidil 5% (massaging into the scalp)
    Red/infrared light 200mW/cm², 2 minutes*
    Essential oil blend: rosemary, lavender, tea tree, peppermint & cedarwood essential oils in carrier oil mix (olive oil, argan oil, black cumin oil, sweet almond oil, etc.)
    *620, 670, 760, 830nm mini combo light device from Red Light Man

    Evening:
    Minoxidil 5%
    Red light 2 minutes
    Retinoic acid** & resveratrol
    Azelaic acid
    **Retinol loses effectiveness from UV exposure so I’m using it only at night

    After each treatment I use the Jenu device (with their microsphere gel) ultrasonic energy to maximise product absorption.

    I’ve also tried 0.3mm roller a few times, hadn’t realised at 0.3mm it shouldn’t be a problem applying minoxidil immediately after, so until now I’ve just been putting on a niacinamide & peptide serum after rolling.

    Besides buying the minoxidil, I haven’t had to buy any of the things mentioned above since I’ve got a bunch of stuff in my fridge – I get skin care products from The Ordinary (azelaic acid for acne, niacinamide + zinc for sebum regulation, retinoid for wrinkles, argan oil for moisturising, resveratrol, superoxide dismutase and EUK134 all powerful antioxidants offering protection from UV & environmental oxidative stress). I’ve got tretinoin too (the more advanced version of retinol & retinoic acid) but that might be too strong for the scalp so I wouldn’t try it. I’ve been using essential oils for awhile and had various carrier oils for massage use, plus the black cumin oil, apple cider vinegar and oleuropein supplements all in the fridge. I got the red light device for wrinkles/acne/muscle pain and then found out people used it for hair growth! Same for the 0.3mm dermaroller and Jenu device, though I’m getting the Dr Pen (derma pen) from Aliexpress and that will have variable needle lengths.

    When I run out of stuff I’m gonna try this “multi peptide serum for hair density” from The Ordinary. Seems inexpensive compared to a lot of products out there. Big list of ingredients:
    Aqua (Water), Propanediol, Butylene Glycol, Glycerin, Caffeine, Biotinoyl Tripeptide-1, Acetyl Tetrapeptide-3, Larix Europaea Wood Extract, Pisum Sativum Extract, Scutellaria Baicalensis Root Extract, Triticum Vulgare Germ Extract, Glycine Soja Germ Extract, Trifolium Pratense Flower Extract, Camellia Sinensis Leaf Extract, Apigenin, Oleanolic Acid, Arginine, Glycine, Calcium Gluconate, Zinc Chloride, Lactic Acid, Gluconolactone, Dextran, Maltodextrin, Hydroxyethylcellulose, Xanthan gum, Pentylene Glycol, Dimethyl Isosorbide, Polysorbate 20, PPG-26-Buteth-26, PEG-40 Hydrogenated Castor Oil, Trisodium Ethylenediamine Disuccinate, Sodium Metabisulfite, Sodium Benzoate, Phenoxyethanol, Chlorphenesin.

    I also want to experiment with brewing a hair growth tea using stuff I’ve got in my cupboard: ginger, turmeric, ginseng, green tea, rooibos, rosemary, maybe thicken it with hyaluronic acid powder and/or marine collagen powder, plus olive leaf extract and a bit of apple cider vinegar. Add a preservative and store in spray bottle in the fridge. Apply 10 minutes before washing it off in the shower. How does that sound?

    And by the way… this is all for my partner. He’s been worried about losing more hair but has never looked into treatments. I stumbled upon all this stuff and took an interest, and now I’m the one having fun using him as my guinea pig! I do everything when he’s on the computer and I assure him there’s no need for alarm while I apply various products and devices to his head 🙂 Just thought I’d share what I’m doing, I’m not associated with any of the companies mentioned and in fact I’m still waiting to see how effective their products/devices are.

    Reply
  11. Hi Rob,

    I just started with 2x daily topical honey bee venom along with weekly 1.5mm micro-needling using a Dr. Pen. (FYI bee’s are not harmed in extraction…they just sting a glass collection plate and they do NOT die after.)

    I also do scalp massages as well as use good natural based shampoos with keto and coal tar along with a healthy diet rich in good fats and nutrients. I see these as basic preventatives and not sole “cures”.

    I chose to start with bee venom because I knew from back in the day when I was a bee removal expert I learned that bee stings had therapeutic value. The FDA has even cleared bee venom injections to treat allergies to bees and many in the pharma world consider venom from many different sources to be gold mines for future drug development.

    Other research has shown bee venom to aid in certain chronic inflammatory conditions like Rheumatoid Arthritis and others…although I haven’t looked myself at any hard data on that.

    I was curious if any studies had been done on bee venom and hair loss…especially since the venom is recognized as a treatment useful for inflammation…plus it came as an intuitive hunch and felt worth looking into.

    I found this study here which was quite compelling – https://www.jstage.jst.go.jp/article/bpb/39/6/39_b16-00158/_html/-char/en#:~:text=Importantly%2C%20we%20found%20that%20bee,reductase%20receptors%2C%20and%20growth%20factors.

    I’m curious if you have heard of this study or if you have any thoughts on it?

    Note: They studied mice as well as a culture of Human Derma Papilla Cells. They found that the venom applied topically induced a variety of growth factors as well as outperformed Minox. It also was a potent 5AR inhibitor.

    This was enough validation for me to experiment with and it doesn’t carry any known risks other than some redness (or if you’re allergic). My thoughts are to use as an alternative to Minox along with the weekly 1.5mm needling and scalp massages and hope to benefits from the 5AR inhibiting as well. I’ve decided to give it a 90-120 day personal trial.

    If you google bee venom ointment you can find some if you dig around. I found a product called Venex that’s a topical lotion with bee venom as primary ingredient along with black pepper oil. It burns on contact but for me not that bad at all compared to the micro-needles. The burning for me dissipates within 5 to 10 minutes or less.

    Keep up the great work and I appreciate all your articles! I also enjoyed your paper outlining your hair loss theory that goes beyond DHT alone. It makes total sense to me.

    Reply
    • Hey Eric,

      Thanks for your comment. We’ve actually had a discussion about this inside our membership community forums. The gist is that bee venom therapy seems to modulate immunoresponsiveness (in a positive way) for certain autoimmune- / allergen-related conditions. For androgenic alopecia, there’s preliminary evidence that immunosuppressive drugs (like cyclosporine-A) might be hugely beneficial as adjunct therapies. So, there’s certainly a case to be made for therapies like this. However, the evidence (so far) seems to only show benefit for non-androgenic forms of hair loss like alopecia areata.

      Here’s a quote from one of my responses in the forums. Keep me posted with your experiment! I’m looking forward to your results and wish you the best of luck with everything.

      Exploring bee venom will be better served as an article, as there are a lot of case-specific boxes to check before someone is a good fit to even consider it as an intervention. For example, bee venom has 5-alpha reductase inhibiting properties (same as the study you linked in the first comment). So, its use as a topical may translate to improvements DHT-mediated hair follicle miniaturization (i.e., AGA) seen in male and female pattern hair loss. At the same time, there are case reports of diffuse hair loss following a beehive attack on an otherwise healthy adult woman.

      However, in the latter case, the attack was so severe that the woman was hospitalized for five days, and the woman’s sister (also attacked) died from anaphylactic shock.

      Long-story short: while there are mechanisms by which too much bee venom can contribute to hair thinning via the injection of “histamine, mast cell degranulating peptide, melittin, phospholipase A,, hyaluronidase and acid phosphatase”, I’m not really sure that case is a reasonable defense against trying bee venom therapies in a controlled setting.

      After all, there are case reports of bee venom therapy improving alopecia areata, possibly through immune reprogramming / modulation. And bee venom therapies have been used in the past to help people overcome, ironically, bee allergies.

      It’s worth noting that all of these studies are published in relatively lower impact factor journals. That’s not to dismiss their findings, but more so to say that both the quantity and quality of evidence on bee venom for hair growth is still pretty low.

      I’m curious: where are you sourcing your bee venom? On a personal note, I almost tried a similar therapy back in early 2012 – but with topical bee venom + propolis as a potential replacement for topical minoxidil (of which I ended up dropping later that year anyway). I couldn’t find a reliable provider for either product, and that in combination with concerns over applying venom to my head each day eventually led to my discouragement of trying it at all.

      Legally speaking, we all have to protect ourselves here and say that you should consult a doctor before trying this, and that the evidence supporting bee venom + microneedling as a hair growth treatment is essentially non-existent. At the same time, if you happened to continue experiencing zero side effects from applying it to your body scalp, and you do decide to try it on the scalp, we’d all be intensely curious to hear how it goes. I’m sorry for the vagueness of that answer.

      Reply

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