HAIR SUPPLEMENTS: ARE THEY WORTH THE HYPE? ISHRS HAIR RESTORATION EXPERTS EXAMINE THE SCIENCE BEHIND KEY INGREDIENTS IN OVER-THE-COUNTER HAIR GROWTH PRODUCTS

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International Society of Hair Restoration Surgery

Jun 14, 2024, 08:11 ET

CHICAGO, June 13, 2024 /PRNewswire/ -- Despite the glowing testimonials from consumers in advertisements promoting hair supplements to combat hair loss and thinning, hair restoration experts warn that consuming supplements without getting to the root of what is causing hair thinning may not be just a waste of money – it can be hazardous to your hair health.

While there are multiple types of hair loss, certain kinds such as Alopecia Areata (AA), Androgenetic Alopecia (AGA), and Telogen Effluvium (TE) can be associated with or exacerbated by certain vitamin or mineral deficiencies, with the most common being zinc, iron, and vitamin D. However, consuming excess amounts of these substances can also cause hair shedding which can worsen the problem. Hair restoration experts recommend establishing baseline serum levels via routine blood tests to determine whether a deficiency exists prior to supplementing it.

"Before supplementing themselves, a patient should consider an evaluation by a hair loss specialist and even a battery of laboratory tests to determine if they have a reversible cause of hair loss such as a deficiency or excess of vitamins, minerals, or hormones," said Sharon A. Keene, MD, FISHRS, Tucson, Ariz., past president of the International Society of Hair Restoration Surgery (ISHRS). "If levels are normal, supplements will not only lack benefit for the patient's hair loss, but long-term use may create toxic levels of that supplement that will make hair loss worse. This is especially true for fat soluble vitamins that are stored in the body and are difficult to excrete, which includes vitamin A, D, and E."

Since proper nutrition is vital for overall health, including hair health, hair restoration experts can help patients with hair loss determine if they are lacking any essential nutrients. "Individuals with a normal healthy diet probably do not need supplements, while those with restrictive diets may benefit more," said Robert S. Haber, MD, FISHRS, Beachwood, Ohio, past president of the ISHRS. "It is always reasonable to take a daily multivitamin, and menstruating women will often benefit from extra iron supplements."

Vitamin D: Too much, too little can be problematic
Vitamin D is a crucial vitamin for many bodily processes, so supplements are appropriate for many people. Deficiency in vitamin D can cause hair loss, but there are many people with significant vitamin D deficiency who do not experience hair loss. When vitamin D deficiency is determined to be the cause of hair loss, published reports show that supplementation with vitamin D3 can significantly reverse hair loss. Dr. Keene sees deficiency levels in at least 30% of her patients despite living in sunny Arizona, and Dr. Haber advises that anyone living in a cloudy region will benefit from vitamin D supplements.

Dr. Keene adds that consuming too much vitamin D can pose a risk for toxicity, including calcium deposits and hair loss. This is especially important for patients who might not be vitamin D deficient and are taking supplements containing high levels of vitamin D, which can lead to toxic levels when taken long-term and can exacerbate hair loss.

When zinc levels matter
While there are documented cases of zinc deficiency causing hair thinning as is noted with vitamin D deficiency, not every patient with zinc deficiency will see significant hair thinning. Dr. Haber recommends testing for zinc deficiency in patients with diffuse hair thinning but noted that it is not a common cause of hair loss in most patients. When zinc deficiency is identified, Dr. Keene noted some patients report improved hair density with supplementation.

Biotin lacks scientific evidence
Despite the frequency in which biotin is included in supplemental hair loss therapies, it is important to note that the only data supporting its use as a hair growth promoter occurs in patients with acquired or inherited biotin deficiency. Dr. Keene stresses that there is no scientific evidence that biotin supplements will promote hair growth in healthy patients, and there is no single supplement that would treat an unrelated cause of hair loss. In this case, biotin supplements will not treat any conditions except biotin deficiency. In addition, biotin supplements can interfere with the accuracy of several blood tests, and Dr. Keene advises that patients taking biotin should stop this for a few days prior to having their blood drawn.

Jury is out on caffeine
Although topical caffeine has generated some buzz for its potential hair growth properties, those who have studied caffeine say one would have to consume toxic levels of caffeinated coffee to get the amount to hair that might benefit it. For this reason, only topical caffeine is recommended by researchers who have studied it. One important limitation of caffeine studies is that increases in hair counts using the established methods of photo-trichogram assessment pre and post treatment were not studied. Other studies have been limited to assessing the efficacy of caffeine-containing shampoos, where caffeine has been documented to easily enter the hair follicle and patient self-reports suggest less shedding is observed. Dr. Haber adds that while there have been some published data that supports the use of topical caffeine for hair loss, there have not been any published studies supporting its efficacy in major medical journals.

Role of iron in hair loss gains momentum
Once considered a debatable cause of hair loss, a growing number of surveys from various countries have associated iron deficiency and low serum ferritin with various types of hair thinning and hair loss. The condition known as non-anemic iron deficiency occurs when hemoglobin concentration is normal but the serum protein called ferritin is decreased, suggesting low iron stores in the body. In many patients, restoring normal iron levels with appropriate iron supplementation will stop hair loss and achieve regrowth of thinning hair.

"One aspect about ferritin or iron deficiency that patients should be aware of is that tannins and oxalates in tea or coffee can inhibit iron absorption if consumed with meals," said Dr. Keene. "Vegans who don't get the more readily absorbed iron from meat should be especially careful to avoid drinking tea and even coffee with their meals or risk developing iron deficiency."

Plant-based procyanidins, peptides pose potential
Polyphenols are chemical substances that are commonly found in fruits, vegetables, and cereals and can include recognizable substances such as resveratrol, quercetin, curcumin, and epigallocatechin gallate, to name a few. While this group of substances has known antioxidant properties, as well as other biologic effects including antibacterial and anti-tumor properties, Dr. Keene has not seen studies to document that such supplements are effective in treating hair loss. Dr. Haber believes that these substances may have potential in treating some forms of hair loss. "Peptides as a class include most growth factors, some of which definitely promote hair growth," said Dr. Haber. "But data on specific peptides is lacking."

Natural anti-androgen supplements
There are several natural supplements known to have anti-androgenic properties relative to inhibiting the production of dihydrotestosterone (DHT), a known contributor to hair miniaturization and hair loss in patients prone to AGA. These natural substances include pumpkin seed, saw palmetto, African Cherry tree, and rosemary oil, among others. However, Dr. Keene points out that she has not seen any large scale, rigorously conducted or long-term studies that document comparable efficacy to finasteride or 5% minoxidil when the latter is used in patients genetically able to convert the pro-drug, minoxidil, into minoxidil sulfate – its active growth promoting form. Patients seeking to use these supplements should understand current study limitations for proving hair growth efficacy.

When ISHRS members were asked about the various treatments prescribed to patients in 2021 in the most recent member survey conducted by the ISHRS, many had mixed feelings about the benefits of supplements. For example, 36% of ISHRS members said that they always/often prescribe "other nutritionals/herbs/vitamins", while 35% said that they rarely/never prescribe these treatments. Only 9.1% of members said that they always/often prescribe saw palmetto, while 79.4% said they rarely/never prescribe it.

Beware of misleading claims
Hair growth supplements often make claims that their products are "clinically tested" or "dermatologist recommended", but consumers need to understand what these claims mean and how they differ from FDA-approved products. For example, the term FDA approved means a certain amount of clinical testing and scrutiny of scientific evidence occurred by a panel of experts to ensure safety and efficacy of a pharmaceutical product. In contrast, labels such as clinically tested or dermatologist recommended may be misleading as they imply similar scientific scrutiny, when in fact they may simply refer to the opinion of a group of doctors – or one doctor – rather than rigorous scientific testing. It is important to note that the FDA does not regulate OTC supplements for purity or perform pre-market safety assessment, and these types of supplements are not allowed to make medical claims. Dr. Keene adds that third party entities – such as consumerlabs.com, US pharmacopeia (USP), and NSF International – provide consumer oversight and assessment for accuracy of quantity and purity for OTC supplements. Supplements that have been evaluated by one of these entities will typically be stamped on the label indicating its verification.

"When it comes to trying hair supplements to treat hair loss or hair thinning, buyer beware is critical to keep in mind – as the FDA approved treatments had to provide patient photo-trichograms that document changes in hair counts at a specific spot on the scalp, and how these changes were maintained over time," said Dr. Keene. "Although there has been some evidence and patient self-reports to support a benefit to OTC supplements, compelling documentation of hair growth associated with rigorous clinical assessment in a large sample size similar to what the FDA requires remains to be seen. At some level of hair loss and miniaturization of hairs, even the most effective FDA-approved medications cannot reverse the process. Only replacing these hairs with transplanted hair via hair restoration surgery can achieve a significant, long-term cosmetic difference."

Dr. Haber adds that consumers should calculate the five-year cost of any therapy for treating hair loss and weigh that cost against the expected benefits. Some of these hair supplement products will have a five-year cost exceeding $5,000, making it usually more cost effective to purchase individual vitamins.

"If a patient experiences hair growth after taking hair growth supplements, they need to be aware that all effective treatments for hair loss must be continued indefinitely – as they do not eliminate the underlying problem," said Dr. Haber. "Discontinuing an effective treatment will lead to hair loss. Hair transplants are the only permanent solution to hair loss, regardless of the extent of hair loss."

For more information about hair supplements, visit the ISHRS website section on nutrition and vitamins.

About the ISHRS
The International Society of Hair Restoration Surgery (ISHRS) is a global non-profit medical association and the leading authority on hair loss treatment and restoration with 1,000 members throughout 70 countries worldwide. Above all, the ISHRS is dedicated to achieving excellence in patient outcomes by promoting the highest standards of medical practice, medical ethics, and research in the medical hair restoration industry. The ISHRS also provides continuing medical education to physicians specializing in hair transplant surgery and is committed to delivering the latest information on medical and surgical treatments to consumers suffering from hair loss, and most commonly from androgenetic alopecia – male pattern baldness and female pattern hair loss. It was founded in 1993 as the first international society to promote continuing quality improvement and education for professionals in the field of hair restoration surgery. For more information and to locate a physician, visit www.ishrs.org.

About the Survey
Conducted by Relevant Research, Inc., of Chicago, IL, USA, the ISHRS 2022 Practice Census is a compilation of information provided solely by participating physicians. The information published in this survey was developed from actual historical information and does not include any projected information. The margin of error for the sample is within plus or minus 6.1 percent at the 95 percent confidence level. For a full reprint of the ISHRS 2022 Practice Census Report, visit Hair Restoration Statistics.

SOURCE International Society of Hair Restoration Surgery