4 effective hair-loss treatments we discovered in 2022

Rogaine is a brand name for the drug minoxidil, which has been FDA-approved as a topical treatment for baldness since 1988.

But the drug was never originally designed to put on your head. It was actually developed to treat high blood pressure. In 1979, the FDA approved a minoxidil-based drug by Pfizer, called Loniten, to treat blood pressure.

It was only later discovered how well minoxidil could grow hair. That's when the topical solution called Rogaine — from The Upjohn Company, but now owned by Johnson & Johnson — became available as a foam or lotion.

This year, more than four decades later, dermatologists are still using minoxidil to treat hair-loss, but differently. It's now something of an open secret in the field that a tiny dose of oral minoxidil — the same pill that doctors prescribe at a higher concentration to treat hypertension — can work just as well as the head rub Rogaine. And it's dirt cheap, too.

Like Rogaine, oral minoxidil doesn't work for everybody who's balding, but it's a nice alternative to the sticky topical formulation of the medicine, which can be a hassle to apply.

Alopecia areata is different from hormonal or genetic hair loss.

It's an autoimmune condition that triggers inflammation inside your skull, around the root of the hair shaft.

"Once that inflammation occurs, the hair becomes thinner and falls out, and then it gets stuck in a part of the hair cycle where it doesn't grow," Mostaghimi explained.

This can result in round, smooth bald patches, or even complete hair loss all over the body.

Mostaghimi said the genetic research to make this new drug possible started in the late 1990s, when a patient advocacy group (The National Alopecia Areata Foundation) partnered with Columbia University to do genetic sequencing on alopecia areata patients.

Over the years, they've discovered how people with alopecia areata have more mutations in their JAK-STAT pathway, a critical component of the immune system that is also targeted to treat other diseases like rheumatoid arthritis and psoriasis.

In June, the FDA approved rheumatoid arthritis drug Olumiant (baricitinib) to treat alopecia areata, after successful late-stage trials. Scientists found that a four-milligram dose of the drug led to "significant scalp hair regrowth" within a year for 40% of patients. That meant around 80% or more scalp coverage.

Ritlecitinib, a once daily pill from Pfizer, is under FDA review. If approved, it would be available to alopecia areata patients 12 and up.

Another pharmaceutical maker, Concert, is also trialing a twice daily pill for alopecia areata (CTP‑543). Its results look promising too: some patients trialing the drug were able to regrow a near-full head of hair.

Mostaghimi, whose daughter has alopecia areata, said it would be great to "go from having no FDA-approved options" to treat the condition earlier this year "to, hopefully, up to three, by 2024."

Mostaghimi says he was "inspired by my patients" to research supplements for hair loss.

He knows his patients are "bombarded by ads for all of these supplements" to regrow hair.

"I interpret this as, mostly, the fact that we haven't done our job as the medical field to appropriately develop enough interventions that work," he added.

Because supplement brands can sell and market products without undergoing research or FDA approval, "it's difficult to know what is working and why and how."

So the doctor and his colleagues authored a first of its kind systematic review on the safety and effectiveness of supplements for treating hair loss in November.

The data he collected on supplements, he cautioned, is still "of limited value," because most of the research done on supplements is conducted in-house, by supplement companies themselves.

Add to that the fact that "any negative studies were just likely never published," and it's very hard to tell how well supplements can actually work to grow hair.

The reality is that "for the vast majority of types of hair loss, we have better pharmaceutical interventions" that "provide more consistent and reliable impact" than supplements, Mostaghimi said.

Drugs like minoxidil (Rogaine) and finasteride (Propecia) are typically cheaper than pricey supplements.

Mostaghimi says he doesn't bother with supplements to treat his own genetic alopecia.

"For me, it's not the right treatment, and I don't actually encourage my patients to take these medications," he said.

But, for patients who are "dead set" on supplements, he does recognize that there are some which "take advantage of pathways that we already target in dermatology with medication." For example, the plant called saw palmetto, which can be bought as a supplement, targets the 5-alpha reductase pathway, important in the development of male pattern baldness.

Studies have suggested saw palmetto supplements may help treat some baldness, but finasteride does the job better, and more cheaply, Mostaghimi said.

"Eventually things like that will happen, and when they occur, they'll look like they're an overnight success, whereas in fact, you've been working on this since 1970," Mostaghimi said.

There isn't yet any one-size-fits-all hair loss treatment, in part because "the biology is just very complex."

Some hair loss is genetic, some hair loss is autoimmune, some hair loss comes as a side effect of cancer treatment, or it can be the result of tight hairstyles.

"Hopefully, we'll continue to make breakthroughs," Mostaghimi said, "but, for now, these are the main treatments we have."