In the vast majority of cases, hair loss is not associated with vitamin-supplement deficiencies. However, the following supplementation maybe beneficial-

• Saw Palmetto: is a powerful natural supplement that can reduce conversion of testosterone to dihydrotesterone. Hence this may be a useful adjunct for the management of androgenetic alopecia (male & female pattern hair loss).
• Iron: supplementation may improve telogen effluvium due to low ferritin levels. The most common cause/s include heavy menses & low intake of dietary iron.
• Multivitamins: may have a role for dietary supplementation in patients who have telogen effluvium due to caloric restriction. Look for a multivitamin formulation with biotin, iron & zinc. Isoflavones or flavonoids can theoretically improve some forms of hair loss. Clinically their efficacy is low.

Microneedling is an effective way to treat some forms of hair loss, including androgenetic alopecia in men and women. Dermatology clinics like Cutis use high speed pens & lasers to achieve a similar treatment.

Microneedling works via two routes, firstly it enables topical medications like minoxidil to penetrate the scalp, allowing for better absorption. Secondly, microneedling gives controlled injury to the upper layers of skin. In turn this causes a cascade of events resulting in stimulation of stem cells in hair follicles.

This is what hair loss clinics don’t want to reveal. Home microneedling, done properly is just as effective as clinical needling at a fraction of the cost. The most important concept to understand is that you do not need to needle deep as stem cell stimulation of the hair follicles occurs with superficial treatments. 

Here is how to do it-

1. Buy several Dermarollers or Stamper from eBay or Amazon. Choose between 0.2 to 0.25 mm. They cost approximately 3-5 USD. For home use, I recommend a stamping system as they require less skill to use.
2. Wash your hair with normal shampoo. Dry accordingly.
3. Ideally have someone help you. This is much easier & you will get a more even treatment.
4. Start in the middle hairline part, then stamp back towards your top (vertex). Firm pressure. With a 0.2 to 0.25 mm stamper, you may get some pinpoint bleeding, but this is not a reliable endpoint.
5. Stamp (or roll) 3-5 passes before going to the sides. For male pattern hair loss you should concentrate on the front hairline & vertex or crown. Female pattern hair loss is more diffuse, hence you may require to stamp a greater area.
6. You can apply topicals within 5 to 20 minutes after microneedling. Remember microneedling breaches the upper layer of the skin, resulting in better penetration of topicals. This includes OTC topicals such as minoxidil 2-5%, or compounded topicals such as finasteride 0.1 to 0.25 mg with minoxidil.
7. Repeat this process every 10 – 21 days.

You may get transient stinging after topical application as most formulations contain alcohol. Additionally, the rate of irritant contact dermatitis (itch) is higher post microneedling. In rare cases an allergic reaction to propylene glycol may occur. If so, swap to a PG free formulation (foam minoxidil).

Low level laser therapy (LLLT) is also known as Light Emitting Diode (LED) therapy. The majority of sources produce intense light in a wavelength of 600 to 1000nm, delivered over 8 to 30 minutes.

The premise behind LLLT is that light suppresses inflammation & stimulates the hair follicle. Do they work? Clinical studies using super powerful in clinic light sources (they typically cost between $15,000 to $35,000) show good efficacy, especially in combination with medical therapy. Dermatologists at Cutis prescribe LLLT using these devices.

Home kits typically range from $200 to $1600. They can be useful adjunctively, however they would not be my first choice for DIY treatments. Topicals such as minoxidil coupled with microneedling are far more effective & cost a fraction of the costs.  My suggestion is that if you would like to consider LLLT, book in with a dermatologist to see if this treatment is effective.

A good way to determine if things are working (or not) is to take baseline photographs. Take a series of photos from front on, side on & the top. Most hair treatments take 3-6 months before working, so be patient. 

If hair loss is progressive, obtain a referral to a medical dermatologist. They can assist with a diagnosis & formulate a treatment plan. Dermatologists are experts in all forms of hair loss, from common male/female pattern alopecia to super rare conditions, including genetic hair disorders.

DIY-home treatments are cost effective & work just as well, if not better than many ‘Hair Loss’ centers. The routine below is for androgenetic alopecia or male/female pattern hair loss. It is not designed for the treatment of other causes of hair fall.

• Minoxidil 5% 30mls $15: about 50 cents a day.
• Saw Palmetto; approximately 50 to 90 cents a day
• Ketoconazole/Nizoral shampoo. $12 for 1-2 months
• Microneedling Roller or Stamp (0.2 mm); $3-$5 dollars

Minoxidil is cost effective. In fact, the price of this topical is only one fifth of the original price two decades ago as Regaine had the patent. Generic lotions are available from most pharmacies. Purchase a 3 to 6 month supply as this is more cost effective.

Dermatologists are experts in the management of all forms of hair loss- from simple male/female pattern baldness, to complex immune mediated hair loss. For cases of androgenetic alopecia, they prescribe-

• Minoxidil: Liquid or foam, compounded 3-7%  concentration often with topical finasteride 0.1 to 0.25%. In some cases, we use 1-2 mg oral minoxidil.
• Finasteride or Dutasteride orally as indicated.
• PRP or platelet rich plasma.  In this treatment, a patient’s blood is drawn and placed into a centrifuge to extract plasma that is injected into the scalp. Growth factors & chemokines found in platelets can stimulate hair growth. A study published in the International Journal of Molecular Sciences found that PRP treatment increased the number of hairs and overall hair density (Gentile, 2017).
• Low-level laser light therapy (LLLT) in the 600 to 1000 nm wavelength  is an effective method to treat hair loss. They emit a constant red LED light that is believed to reduce inflammation and increase blood flow to the hair follicles.
• Thulium laser is another effective non-pharmacological method to revive hair counts. The 1927 nm laser stimulates follicles. This is best used with topicals or medical therapy.
• Hair Transplant Surgery: In FUE or follicular unit extraction, donor hairs are removed from the sides and back of the scalp (areas which are more resistant to DHT) and implanted into areas of male pattern baldness.

Disclaimer: I am a procedural dermatologist, for diagnosis & medical management, book a consult with my colleagues at Clinic Cutis.