Hair today… gone tomorrow? Don and Steve are combing through the claims to find out what really works. In this episode, they separate fact from fiction about hair loss treatments, tackling everything from minoxidil and finasteride to natural remedies and trending techniques.
💊Does oral minoxidil really outperform topical versions?
🧴Is topical finasteride genuinely a safer workaround, or do the same systemic side effects still sneak through?
🌿Are “natural” options like rosemary oil and saw palmetto actually regrowing hair… or just regrowing rumors?
Bad hair days meet bold claims — and our hosts are on the case. Strands, studies, and “so‑called solutions”… they pull out the magnifying glass to uncover the clinical truth.
They’ll share research and insights into some eyebrow‑raising claims, including:
- Oral minoxidil is more effective than topical versions for hair loss.
- Topical finasteride doesn’t have systemic side effects seen with oral tablets.
- Combining topical minoxidil with oral finasteride may be more effective than using them alone.
- Saw palmetto and rosemary oil are effective for hair loss
Plus, they tackle a trio of quick-hit myths—from family “in-hair‑itance” to grooming habits…and even a surprising pet danger.
Our listeners can get 10% off a new or upgraded subscription with code rvt1026b at checkout.
TRC Healthcare Editor Hosts:
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD, PMSP
Guest:
- Jeff Langford, PharmD, BCPS, BCCP (Managing Clinical Editor at TRC Healthcare for NatMed)
CE Information:
None of the speakers have anything to disclose.
TRC Healthcare offers CE credit for this podcast for subscribers at our platinum level or higher. Log in to your Pharmacist’s Letter, Pharmacy Technician’s Letter,or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Chart: Treatment and Prevention of Hair Loss
- Article: Get to the Root of Male Pattern Baldness Treatments
📣 New Podcast!📣
🌱Natural Medicines: Evidence in Practice
Evidence, not hype. Concise, clinician‑ready guidance on natural medicines and integrative care. Episode 1: GLP‑1s & Nutrition is live now!
Email us: [email protected]
The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.
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Transcript:
This transcript is automatically generated.
00:00:05 Narrator
Welcome to Rumor vs. Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.
00:00:13 Narrator
Today, we’ll split hairs over claims about hair loss.
00:00:22 Don Weinberger
Whoa, I think our producer started this video a little too soon.
00:00:26 Don Weinberger
Steve, what are you doing?
00:00:28 Steve Small
Sorry, I was getting ready. I was putting some hairspray on.
00:00:31 Don Weinberger
Oh, is that your regimen?
00:00:32 Steve Small
It takes a lot to look this beautiful.
00:00:33 Don Weinberger
I guess so, yeah.
00:00:35 Steve Small
For these episodes.
00:00:37 Don Weinberger
Well, that’s good.
00:00:39 Don Weinberger
Sorry, folks, you should tune into the YouTube.com to see what Steve actually was doing.
00:00:44 Don Weinberger
Anyways, I am Don the Pharmacist.
00:00:47 Steve Small
And I’m Steve the Pharmacist.
00:00:48 Don Weinberger
In this episode, we’re going to comb through claims about hair loss.
00:00:53 Don Weinberger
As Steve was kind of spraying there, so we’re going to shed some light on why hair falls out and which treatments might actually convince it to stick around.
00:01:01 Steve Small
Right, and before we get into the right headspace here, I want to emphasize that this podcast offers continuing education credit for pharmacists, pharmacy technicians, prescribers, and nurses.
00:01:12 Don Weinberger
And so just log into your Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
00:01:22 Steve Small
And for the purposes of disclosure today, none of the speakers have anything to disclose.
00:01:26 Don Weinberger
Okay, so before we jump into these claims, let’s brush up a little on some Hair Loss 101.
00:01:32 Don Weinberger
That’s, you know, male and female pattern baldness, also known as androgenic alopecia, where the androgen dihydrotestosterone, or DHT, binds to DHT‑sensitive hair follicles.
00:01:46 Don Weinberger
DHT is converted from testosterone by an enzyme called 5‑alpha reductase.
00:01:50 Don Weinberger
And over time, the DHT molecule actually signals those poor follicles to just shrink and stop producing visible hair.
00:02:00 Don Weinberger
So that’s essentially the root of the problem.
00:02:04 Steve Small
Right, and androgenic alopecia is not the only source of hair loss we have to think about.
00:02:08 Steve Small
There’s also alopecia areata, which is an autoimmune condition where the immune system attacks the hair follicles, causing sudden patchy hair loss, typically the size of maybe a coin.
00:02:18 Steve Small
And then there’s also telogen effluvium, where hair loss is sudden due to increases in stress, hormone imbalances, things like that.
00:02:26 Steve Small
And we actually talked about this type of hair loss during our GLP‑1 side effects episode just a little far back.
00:02:31 Steve Small
So go ahead and check it out.
00:02:32 Don Weinberger
A good call out. That’s right.
00:02:33 Don Weinberger
So if you want to stick around to the end, we have a listener question from our last episode about menopause, asking if black cohosh affects estrogen levels.
00:02:42 Steve Small
Yeah, looking forward to that.
00:02:44 Steve Small
And with that, let’s jump to our first claim here.
00:02:47 Steve Small
And let’s curl up about this first hair loss claim we keep getting.
00:02:51 Steve Small
It’s oral minoxidil is more effective than topical versions for hair loss.
00:02:57 Steve Small
So to kind of look back and recap on this, oral minoxidil is an old drug from the 1960s, used as a vasodilator usually to treat high blood pressure.
00:03:07 Steve Small
And during treatment, one peculiar side effect that patients noticed at the time was increased hair growth all over the body.
00:03:14 Steve Small
And possibly because vasodilated blood vessels bring more blood and nutrients to follicles and help feed them, help them grow.
00:03:21 Steve Small
So minoxidil for hair loss was born after that.
00:03:24 Steve Small
Oral minoxidil can have rare risks, including side effects like heart palpitations, swelling in the legs, and things like that.
00:03:32 Steve Small
So in the 1980s, a topical version of minoxidil was FDA‑approved specifically for hair loss.
00:03:37 Don Weinberger
Yeah, oh yeah, we did talk about minoxidil and hair growth in our Retro Rumors 40th anniversary episode.
00:03:45 Don Weinberger
Okay, so let’s fast forward to recent times, right?
00:03:49 Don Weinberger
The question is, why is oral minoxidil becoming more popular for hair loss again, especially since this is prescribed without FDA approval or what we call off‑label?
00:03:59 Steve Small
Yeah, off‑label indeed.
00:04:01 Steve Small
There was a New York Times article back in 2022 that stated oral minoxidil was an option for patients, when topical options maybe didn’t work.
00:04:11 Steve Small
So the interest really did sprout from there, you could say.
00:04:14 Steve Small
But from randomized controlled clinical trials with this that came out afterwards, the results aren’t as clear as that.
00:04:21 Steve Small
One head‑to‑head trial that we found showed that 2.5 milligrams of oral minoxidil daily produced more hair counts and better thickness than 5% topical minoxidil at six months.
00:04:32 Steve Small
But keep in mind, the study only enrolled 42 people.
00:04:35 Steve Small
That’s pretty small.
00:04:37 Steve Small
But there was a meta‑analysis of four studies published back in 2025, just a little while ago, that showed no superiority between oral and topical minoxidil.
00:04:46 Steve Small
Essentially, both forms may help increase hair density, generally around 10 to 20 hairs per square centimeter, to give you some context.
00:04:54 Steve Small
And they had similar side effects, but neither clearly outperforms the other overall.
00:05:00 Steve Small
And also keep in mind, this is only in about 270 patients overall, again, a small number.
00:05:05 Steve Small
Plus the dosing strategies even changed too. So hard to really piece that out.
00:05:08 Don Weinberger
Important points. Important points, but even more important point based off what you said is we can’t have, or can we have those glorious locks of hair after taking this?
00:05:21 Steve Small
Right. It’s all about the hairdo.
00:05:23 Steve Small
And it’s not necessarily that.
00:05:26 Steve Small
Patients may get some hair growth, but results can vary.
00:05:30 Steve Small
And some patients may have not really noticeable hair growth at all.
00:05:34 Steve Small
Maybe it’s just stopping their hair loss or stopping where it’s already at.
00:05:37 Steve Small
And there’s very few comparison studies that looked at patient satisfaction between oral and topical minoxidil here.
00:05:46 Steve Small
The evidence we do have is mixed.
00:05:47 Steve Small
For example, one study showed that roughly one‑third of patients in both groups had low satisfaction and only one in five had high satisfaction.
00:05:57 Steve Small
That’s quite a spread.
00:05:58 Steve Small
So you shouldn’t expect to grow a fantastic hairdo miraculously with these meds, Don.
00:06:03 Don Weinberger
Okay. So bummer. Thank you for that.
00:06:06 Don Weinberger
But you know, just like that New York Times article and also from what I’m seeing from our subscribers as well as social media there may be a preference, though, for those oral minoxidil forms because of ease of use, right?
00:06:21 Don Weinberger
Or maybe the topical minoxidil didn’t really work out in the end.
00:06:24 Don Weinberger
So they do want to try it.
00:06:27 Don Weinberger
What’s the advice here?
00:06:29 Steve Small
Yeah, I’m glad you brought that up.
00:06:31 Steve Small
I’d say the first thing is to ensure patients are given topical minoxidil a fair shake here.
00:06:36 Steve Small
Due to the length of the hair cycle, it’s important to point out to patients that they should expect to take at least three to six months to even notice any results, maybe even up to a year potentially.
00:06:46 Steve Small
And it’s got to be with consistent use.
00:06:48 Steve Small
The minute you stop, you’re not going to get results.
00:06:51 Steve Small
And again, it’s possible for patients to not see any major results and they may be unsatisfied with it.
00:06:58 Steve Small
So I would say also, based on the evidence we do have, it’s reasonable to expect the same approach with oral minoxidil.
00:07:05 Steve Small
But if someone really does want to try oral minoxidil because it’s only once a day rather than twice a day like the foam or the solution, here are some study doses that we found.
00:07:15 Steve Small
You could start low and slow, maybe at 1.25 milligrams daily, increasing by 1.25 milligrams every three months to a max of 5 milligrams per day.
00:07:26 Steve Small
And for women, it’s half that dosage, typically starting at 0.625 milligrams daily, titrating every three months but then to a max of 2.5 milligrams a day.
00:07:36 Don Weinberger
Right. So that’s a, as far as titration schedules, you know, we’ve seen a medication that’s a pretty, you said low and slow, you meant it, right?
00:07:43 Don Weinberger
That’s what the study was.
00:07:45 Don Weinberger
My guess… is this due to side effects?
00:07:48 Steve Small
Yes, you’re totally right.
00:07:49 Steve Small
It can cause issues like swelling and rapid heart rate, things we were talking about earlier.
00:07:53 Steve Small
So low and slow is the way to go here.
00:07:56 Steve Small
And doses can be divided across the day.
00:07:58 Steve Small
So maybe splitting your daily dose into a morning and nightly dose to help decrease those side effects.
00:08:04 Steve Small
And we need to make sure patients know that oral minoxidil can cause hair growth on any part of the body, not just the head now.
00:08:10 Steve Small
So that’s something they need to expect.
00:08:12 Don Weinberger
Right.
00:08:13 Don Weinberger
That’s actually a really good point as well, counseling point for, you know, for anybody getting this to the pharmacy.
00:08:18 Don Weinberger
So to go back to topical minoxidil, though, let’s kind of reassure people that’s not necessarily side effect free either, right?
00:08:28 Don Weinberger
There are some on the label saying that irritation of the scalp can happen, hair greasiness or like the feeling of a solution in the hair.
00:08:38 Don Weinberger
It can be an issue, although that’s due to the propylene glycol that’s actually in topical minoxidil.
00:08:44 Don Weinberger
And some other dosage forms like foam don’t have propylene glycol, so that could be recommended for people who don’t really want their hair greasiness.
00:08:51 Don Weinberger
And also with topical minoxidil, systemic absorption can occur, especially when it actually runs off into those thin-skinned areas of the body, like or the face, so like the cheeks or the forehead or the neck.
00:09:03 Don Weinberger
So make sure you’re pointing those package directions for patients so they apply it correctly.
00:09:10 Steve Small
Yeah, and really reading that packaging is key because overuse can be an issue too, where you may not see better effects.
00:09:16 Steve Small
You might just see more side effects.
00:09:18 Steve Small
For example, one mL of solution per dose is recommended.
00:09:22 Steve Small
And that doesn’t seem like a whole lot when you look at it, but that is what’s recommended.
00:09:26 Steve Small
So going back to this claim that oral minoxidil is more effective than topical versions for hair loss, the verdict is rumor with conditions.
00:09:39 Steve Small
Patients will need to balance side effects here and convenience with these options.
00:09:43 Steve Small
And we need to have realistic expectations since, like we said, results can vary with minoxidil.
00:09:49 Steve Small
And you know, this claim reminds me, Don, wasn’t there a new minoxidil extended-release oral formulation that’s being developed?
00:09:55 Don Weinberger
Yep, there was.
00:09:56 Don Weinberger
Minoxidil ER, extended release.
00:09:58 Don Weinberger
I believe it’s an investigational oral formulation just indicated for hair loss.
00:10:04 Don Weinberger
They’re touting steadier drug levels because of the ER formulation.
00:10:08 Don Weinberger
for hair regrowth and maybe even lower risk of side effects.
00:10:11 Don Weinberger
But it’s still in early phases.
00:10:13 Don Weinberger
I think it was recruiting for phase two and phase three, but we will definitely keep an eye on that one.
00:10:18 Steve Small
Yeah, we’ll see.
00:10:19 Don Weinberger
Okay, so let’s keep going with the side effect topic. Okay.
00:10:23 Don Weinberger
The next claim that leads into that is topical finasteride doesn’t have systemic side effects seen with oral tablets.
00:10:31 Don Weinberger
So, you know, as we said, oral finasteride decreases that dihydrotestosterone or DHT.
00:10:38 Don Weinberger
by blocking the 5-alpha reductase enzyme.
00:10:41 Don Weinberger
And side effects are pretty well known by now, which include decreased libido and erectile dysfunction.
00:10:49 Don Weinberger
And that was during the study, but after the drug was marketed, they found that mood changes such as depression and even suicidal ideation were reported among patients actually as early as, I believe it was 2002.
00:11:03 Steve Small
Yeah, that caused a lot of concerns.
00:11:05 Steve Small
And didn’t that lead to labeling changes for finasteride?
00:11:08 Don Weinberger
Yep, sure did.
00:11:08 Don Weinberger
So, oral finasteride package inserts now reflect, you know, the risk of these psychiatric side effects from that post‑market experience.
00:11:18 Don Weinberger
I believe the depression was added in 2011 to the labeling and suicidal ideation was added in 2022.
00:11:28 Don Weinberger
So, those are both appear on that package insert now.
00:11:31 Don Weinberger
So, as you can see, based off that, the reason why topical finasteride kind of, you know, shot forth was to kind of have that same effectiveness as oral finasteride by applying, you know, finasteride directly to those hair follicles, but with the hopes of having less systemic absorption because it’s a topical, right.
00:11:54 Steve Small
Right, and it’s important that topical finasteride is not FDA approved.
00:11:59 Steve Small
We should point that out.
00:12:00 Steve Small
You need to get it from a compounding pharmacy.
00:12:02 Steve Small
And regarding its goal here, aiming and hitting the target are two different things.
00:12:06 Don Weinberger
Yeah, bullseye.
00:12:08 Don Weinberger
So published clinical trial evidence comparing both dosage forms directly against each other is actually, it’s at this point actually, it’s very limited.
00:12:17 Don Weinberger
In terms of improving hair density and counts, they may be the same.
00:12:22 Don Weinberger
You mentioned earlier about 10, 20 hairs.
00:12:23 Don Weinberger
That’s about here, about 20 hairs per centimeter squared as far as increase is concerned.
00:12:29 Don Weinberger
As you know, we do need more data before we can say for certain that topical finasteride is more effective than oral versions.
00:12:36 Don Weinberger
So that’s effectiveness. What about safety?
00:12:40 Don Weinberger
And FDA actually released something recently.
00:12:43 Don Weinberger
It was April of 2025, whenever you’re listening to this, and reported
00:12:48 Don Weinberger
there’s actually some serious systemic adverse effects with that compounded topical finasteride, including dysfunction, anxiety and depression, suicidal ideation.
00:12:58 Don Weinberger
So the same stuff we were seeing with the oral finasteride dosing, right?
00:13:03 Don Weinberger
And just like oral finasteride, in some patients, those symptoms actually persisted even after they discontinued that topical med.
00:13:12 Don Weinberger
Man, we do need more studies before we can say the risk
00:13:18 Don Weinberger
these side effects are actually lower with topical than oral.
00:13:22 Steve Small
Yeah, we need to get the data.
00:13:23 Steve Small
So ensure patients know the facts before they try something here.
00:13:26 Don Weinberger
Let them know.
00:13:27 Don Weinberger
So going back to that claim, it is topical finasteride doesn’t have systemic side effects seen with oral tablets.
00:13:35 Don Weinberger
And the verdict is rumor.
00:13:42 Don Weinberger
Topical finasteride has been shown to have the same side effects as oral versions.
00:13:47 Don Weinberger
And it’s too soon to say if risks of them are lower with topical.
00:13:51 Don Weinberger
More time and research will tell.
00:13:54 Steve Small
Yeah, so there is a risk of side effects regardless if it’s oral or topical here.
00:13:58 Steve Small
But let’s say patients want to try topical finasteride. What should they know?
00:14:03 Don Weinberger
Yeah, so there will be some patients who say, I want to try topical anyways.
00:14:06 Don Weinberger
So let’s go ahead and steer them in the right direction, right?
00:14:08 Don Weinberger
So get the product from a reputable US licensed compounding pharmacy.
00:14:13 Don Weinberger
So looking at this, there were some fakes out there.
00:14:15 Don Weinberger
So ensure they’re getting it from that reputable source.
00:14:20 Don Weinberger
And also, dispensing finasteride in pharmacy, the oral version anyways, there’s an auxiliary label you actually put on this picture saying, make sure pregnant patients do not touch this.
00:14:29 Don Weinberger
So of course, with topical finasteride, that’s still the same.
00:14:32 Don Weinberger
You know, with, you know, patients apply to their hair, their hair touches, you know, pillowcases or people or clothes.
00:14:38 Don Weinberger
So make sure patients understand that to keep this away from pregnant patients in their households.
00:14:45 Steve Small
Really good call out there.
00:14:46 Steve Small
And before we get into our next claim, if this episode helps you cut through the clutter, here’s a little something to level up your game.
00:14:53 Don Weinberger
Are you a subscriber? Don’t forget to claim CE credit for this episode.
00:14:57 Steve Small
And not subscribed yet or thinking about upgrading?
00:15:00 Steve Small
Access more trusted clinical insights and save 10% with our exclusive listener promo code RVT1026 at checkout.
00:15:09 Don Weinberger
And details and links are in the show notes, so don’t miss out.
00:15:13 Steve Small
Now let’s try something new here, fast facts.
00:15:16 Don Weinberger
This is where we jump into some common bite-sized claims about hair loss and give them seal approval or debunk them quickly.
00:15:30 Steve Small
Great, and hair we go.
00:15:32 Steve Small
So the first claim here is that hair loss comes from the maternal side.
00:15:36 Steve Small
And the reality here is that genes for hair loss are multifactorial.
00:15:39 Steve Small
It comes from mom, dad, grandfathers, grandmothers.
00:15:42 Steve Small
There is no on-off single switch or gene.
00:15:45 Steve Small
It comes from multiple sources.
00:15:46 Steve Small
So the verdict here is rumor with conditions.
00:15:52 Steve Small
And I think I’m ready for another quick claim here, Don.
00:15:54 Don Weinberger
Sure, so the claim is wearing hats or shampooing hair often can cause it to fall out.
00:15:59 Don Weinberger
Some medical reviews confirm that no direct link between hats and hair loss, except in special cases like very tight headwear that can cause something called traction alopecia.
00:16:11 Don Weinberger
Frequent shampooing does not cause hair loss either, because shampoo does not kill or damage hair follicles.
00:16:16 Don Weinberger
Hair seen shedding in the shower is usually hair that was already ready to fall out naturally as part of the hair cycle.
00:16:22 Don Weinberger
So the verdict is true with conditions.
00:16:27 Don Weinberger
And I love doing fast facts.
00:16:29 Don Weinberger
Steve, should we do one more?
00:16:32 Steve Small
You betcha.
00:16:32 Steve Small
This last claim here is that topical minoxidil is toxic to animals.
00:16:37 Steve Small
And yes, minoxidil is highly toxic to cats and dogs, but especially cats.
00:16:41 Steve Small
Even licking a small amount from a human skin or perhaps from a dropper applicator, can be life‑threatening for them.
00:16:47 Steve Small
So like any other medication stored in the home, keep it up and away from children and pets.
00:16:53 Steve Small
So the verdict here is true.
00:17:03 Steve Small
That was a great rapid session, Don. I liked that.
00:17:07 Steve Small
All right, so let’s talk about if patients want to try more than one product.
00:17:11 Steve Small
This next claim is combining topical minoxidil with oral finasteride may be more effective than using either of them alone.
00:17:20 Steve Small
Now, minoxidil and finasteride tackle hair loss through two completely different mechanisms like we talked about before.
00:17:26 Steve Small
So the thought is maybe using them together could create a synergistic effect.
00:17:30 Steve Small
So remember, oral finasteride lowers that DHT hormone that causes follicle miniaturization, whereas minoxidil improves blood flow and prolongs the hair growth phase.
00:17:41 Steve Small
Now, because they act on different pathways, maybe combining them boosts both follicle preservation and new growth here.
00:17:49 Steve Small
And a randomized trial of about 400 men found that this combo of topical minoxidil 5% twice daily plus oral finasteride 1 milligram daily produced significant improvements in hair density, hair diameter, and overall photographic assessment, outperforming minoxidil or finasteride alone.
00:18:08 Steve Small
So that’s interesting.
00:18:09 Don Weinberger
It is. It does make sense.
00:18:11 Don Weinberger
You know, you’re tackling, like you said, those two causes of hair loss.
00:18:15 Don Weinberger
So what should patients be aware of when they’re, when they’re using these products, whether alone or as combination, as far as results or expectations.
00:18:27 Steve Small
Right. Keep in mind, the data here is still pretty limited doing this combination, but the results seem promising.
00:18:33 Steve Small
But we have to be real here.
00:18:34 Steve Small
Hair growth with these products is only temporary and will return back to baseline in about three to six months after stopping these meds.
00:18:41 Steve Small
And the only long-lasting treatment is a hair transplant.
00:18:45 Steve Small
So taking follicles from the back of the hair and then moving them to the thinning areas of the scalp.
00:18:51 Steve Small
So it’s pretty invasive.
00:18:52 Don Weinberger
It sounds ouch too, but adds meaning to the phrase, beauty comes with pain, right?
00:19:00 Steve Small
Yes, that’s a very true phrase.
00:19:02 Steve Small
So when it comes to this claim that combining topical minoxidil with oral finasteride may be more effective than using them alone, the verdict is…
00:19:14 Steve Small
True.
00:19:15 Don Weinberger
Yeah. So what about, I have patients that do ask using an oral and topical of the same active ingredient.
00:19:22 Don Weinberger
So like an oral and topical finasteride, kind of get that DHT blocking at every angle.
00:19:28 Don Weinberger
Like what’s the advice there?
00:19:30 Steve Small
Yeah, like dunking your whole head in finasteride there in a way.
00:19:35 Steve Small
But using both at the same time may not really provide added benefit here.
00:19:39 Steve Small
And instead, it may just increase the risk of side effects because really oral finasteride already saturates most of that 5-alpha reductase enzyme at low doses, such as the 1 milligram per day we’re talking about.
00:19:51 Steve Small
So adding topical finasteride may not meaningfully increase scalp DHT suppression and like we said, could just increase libido issues and other things we want to avoid.
00:20:00 Steve Small
So keeping that in mind.
00:20:01 Don Weinberger
Thanks for coming out of those good points.
00:20:02 Don Weinberger
And we do cover this combo and other options in our treatment and prevention of hair loss chart.
00:20:08 Don Weinberger
Definitely helps tackle those hairy questions about hair loss.
00:20:14 Steve Small
Right.
00:20:14 Steve Small
And take a look at the show notes or description.
00:20:16 Steve Small
We’ve linked directly to that resource in Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights.
00:20:22 Don Weinberger
If you aren’t already a subscriber, don’t miss out on these resources.
00:20:25 Don Weinberger
Sign up today to stay ahead with trusted insights and tools.
00:20:30 Don Weinberger
And for this next claim, we’re trying to find out what works for hair loss if patients want to try the natural way.
00:20:39 Don Weinberger
And the claim here is saw palmetto and rosemary oil are effective for hair loss.
00:20:43 Don Weinberger
To help us out. Early this week, I spoke with Jeff Langford from our NatMed Pro to dig into this.
00:20:48 Don Weinberger
Let’s go to him now.
00:20:54 Don Weinberger
Hey Jeff, glad to pull you away from your own natural medicine podcast to help give us the assist here.
00:21:01 Don Weinberger
I saw that rosemary oil and saw palmetto were the more common ones to use for hair loss as natural medicines.
00:21:09 Don Weinberger
Can you help us untangle this claim?
00:21:11 Jeff Langford
Hey there, Don.
00:21:12 Jeff Langford
Yeah, let’s start by tackling saw palmetto first.
00:21:16 Jeff Langford
Think about how it works and what kind of data we have around that.
00:21:19 Jeff Langford
It seems to work by inhibiting 5-alpha reductase and lowering DHT.
00:21:23 Jeff Langford
So much like what you’ve talked about with finasteride.
00:21:26 Jeff Langford
And in terms of the data, we have a small study that used saw palmetto in male and female patients.
00:21:32 Jeff Langford
They had androgenic alopecia.
00:21:34 Jeff Langford
And in the study, they found that taking saw palmetto oil capsules, 100 milligrams daily, or applying it as a lotion, like a 20% lotion, for over 4 months, reduced hair loss and increased hair density compared to placebo.
00:21:47 Jeff Langford
So it sounds pretty good, right?
00:21:49 Jeff Langford
But there are some limitations to the data.
00:21:51 Jeff Langford
It didn’t improve other parameters such as thickness of hair or subjective measures, like the patient’s assessment of their appearance of hair or their appearance and assessment of their own hair thinning.
00:22:04 Jeff Langford
Other data, used saw palmetto orally in a 320 milligram dose and did that over about two years.
00:22:11 Jeff Langford
In this case, it was less effective than finasteride, 1 milligrams per day.
00:22:17 Jeff Langford
And saw palmetto is out there in all kinds of combination formulations and has been studied with other plant extracts and micronutrients.
00:22:24 Jeff Langford
And some of those studies, those combination therapies, including saw palmetto, increased hair density over six months.
00:22:30 Jeff Langford
So we’ve got a little bit of a hodgepodge of data.
00:22:32 Jeff Langford
I’d say the bottom line here is really that there are some limited data that saw palmetto can improve some assessments, such as hair density, but it may not improve the patient’s own assessment.
00:22:43 Jeff Langford
Which may give us some indication of how important or detectable those benefits really are at the patient level versus the dermatologist level.
00:22:51 Jeff Langford
And it doesn’t seem to work as well as finasteride in a direct comparison.
00:22:55 Don Weinberger
That is interesting because it’s the patient’s kind of own assessment of how their hair is growing is the idea, right?
00:23:00 Don Weinberger
The outward appearance, but that is kind of, that’s interesting kind of observation and what came out of that.
00:23:08 Don Weinberger
So what about the side effects though of saw palmetto? What can you tell us about those?
00:23:14 Jeff Langford
Yeah, good question. So it’s generally well tolerated.
00:23:16 Jeff Langford
GI upset, not surprisingly, is among the most common side effect reported in these studies.
00:23:22 Jeff Langford
But saw palmetto, because of how it works, can have sexual side effects such as erectile dysfunction or reduced libido.
00:23:29 Jeff Langford
Some data have compared that.
00:23:31 Jeff Langford
Again, we saw where it had been studied compared to finasteride.
00:23:34 Jeff Langford
Seems like the side effects, although they are similar in type to finasteride, they may occur less frequently than finasteride.
00:23:42 Jeff Langford
So maybe a little bit better, tollerated in terms of sexual side effects.
00:23:47 Jeff Langford
GI upset is pretty common though.
00:23:49 Don Weinberger
Got it. So it seems like whenever you inhibit that DHT, you kind of get those similar side effects that you’re saying.
00:23:55 Don Weinberger
Okay. So let’s move on to the second natural product and part of that claim, which is rosemary oil.
00:24:02 Don Weinberger
So what do you have for us on that?
00:24:04 Jeff Langford
It sounds to me, Don, like you’ve been looking at some TikTok videos that talk about nature’s Rogaine.
00:24:10 Jeff Langford
And this does…
00:24:11 Don Weinberger
Keep that between us.
00:24:12 Jeff Langford
Yeah, exactly.
00:24:13 Jeff Langford
This comes up from time to time and it’s based on a study that was conducted in 2015.
00:24:18 Jeff Langford
And it showed that a specific formulation of rosemary oil increased hair count in patients with androgenic alopecia.
00:24:25 Jeff Langford
And it did that to a similar degree or a similar amount of increase in hair count as what was seen with a 2% minoxidil solution when these things were compared over a six month period.
00:24:35 Jeff Langford
So that’s where the nature’s Rogaine bit comes from if you’re seeing that or hearing that.
00:24:39 Jeff Langford
But as I say, this evidence is pretty thin.
00:24:43 Jeff Langford
Single study doesn’t suggest that the patients, again, we don’t have suggestion or confirmation that the patients perceived a difference in their hair results.
00:24:51 Jeff Langford
In this case, these hair count results are like a photographic assessment of sections of hair where we can literally count that there are more hairs.
00:25:00 Jeff Langford
Patients may or may not necessarily detect that or appreciate that difference.
00:25:06 Jeff Langford
And again, if we want to think about patients may still want to try it.
00:25:09 Jeff Langford
There are a lot of rosemary oil products that are marketed for hair growth.
00:25:13 Jeff Langford
And if that’s the case, I think some things I would keep in mind or counsel patients about is that well tolerated, but it can cause skin sensitivity or sun sensitivity in particular.
00:25:23 Jeff Langford
So we need to know about that.
00:25:26 Jeff Langford
And the question would generally come up about topical versus oral use.
00:25:31 Jeff Langford
We know that rosemary is safe to eat in terms of as an herb or a seasoning, but we’re talking here about essential oil from rosemary and people should not take that undiluted orally.
00:25:44 Jeff Langford
In that case, it really can, has the potential to, cause serious side effects, including seizures.
00:25:49 Jeff Langford
And there’s no evidence for oral rosemary to help hair loss.
00:25:53 Jeff Langford
So if people want to try it, guide them toward a topical product, explain the potential skin and sun sensitivity they may experience.
00:26:02 Don Weinberger
Okay. So thank you very much, Jeff, for your sage advice, again, when it comes to tackling these hair loss claims.
00:26:10 Don Weinberger
So I’ll send you on back to your own Natural Medicines: Evidence in Practice podcast.
00:26:16 Don Weinberger
So let’s go kick it on back to Steve and get his thoughts on what you said and the verdict.
00:26:25 Don Weinberger
Okay, Steve, what did you think about what Jeff had to say about those natural medicines?
00:26:29 Steve Small
I always love to hear Jeff’s natural takes to these things.
00:26:33 Steve Small
You know, in the hospital, we don’t deal with saw palmetto or rosemary oil.
00:26:36 Steve Small
So this is really interesting.
00:26:38 Steve Small
And I’m looking forward to listening to his upcoming premiere for his team’s podcast.
00:26:42 Don Weinberger
So do I. So going back to that claim is saw palmetto and rosemary oil are effective for hair loss.
00:26:47 Don Weinberger
And the verdict is…
00:26:51 Don Weinberger
Evidence is mixed.
00:26:54 Steve Small
Nice. You know, Don, for now, I’m going to keep my rosemary oil in my kitchen cupboard, not the medicine cabinet.
00:27:00 Steve Small
But for patients trialing rosemary oil, it’s recommended for a three-to-six-month time frame.
00:27:06 Steve Small
And what about scalp irritation?
00:27:07 Steve Small
And don’t combine with oral finasteride without discussing with the provider first for more info.
00:27:13 Steve Small
And you know, Don, I saw some interesting items used for hair loss, including cooling caps and microneedling.
00:27:19 Steve Small
Can you pinpoint the reasoning here for me?
00:27:22 Don Weinberger
Right, to kind of…I did see those as well.
00:27:25 Don Weinberger
So cooling caps are thought to, they’re more used with oncology patients when they’re receiving chemotherapy.
00:27:32 Don Weinberger
And the cooling actually causes scalp vasoconstriction and slows that hair follicle from uptaking that chemotherapy and impact of chemotherapy on that follicle.
00:27:43 Don Weinberger
The results actually kind of depend on which kind of therapy was used in those patients.
00:27:48 Don Weinberger
But keep in mind that approach was only studied really for oncology patients and not general patients with male, female pattern hair loss.
00:27:57 Don Weinberger
I mentioned microneedles, right?
00:27:59 Don Weinberger
So that’s another interesting kind of, you know, device to use for hair loss.
00:28:06 Don Weinberger
It’s usually on a roller.
00:28:07 Don Weinberger
I’ve seen some actually have like a motorized machine and they make these tiny skin punctures basically to increase blood flow and all those growth factors into those kind of micro wounds they make into the scalp, which nourishes new hair follicles or hair growth from existing follicles.
00:28:24 Don Weinberger
But with that, studies are mixed.
00:28:28 Don Weinberger
But microneedling actually might help topical medications absorb into the scalp better by letting them penetrate, you know, creating all those micro‑abrasions.
00:28:37 Don Weinberger
But just keep in mind that no microneedling devices are FDA cleared specifically for hair loss, but some actually are cleared for things like wrinkles and scars.
00:28:48 Steve Small
Yeah, that’s already making my head itch, Don.
00:28:51 Steve Small
Speaking of head scratcher, let’s get to the bottom-line truth here, that treatments for hair loss aren’t cut and dry.
00:28:57 Steve Small
Ensure patients really get the facts with hair loss products so they can make informed decisions.
00:29:01 Don Weinberger
Right, so we have tools available to patients can get all the facts they need from Pharmacist’s Letter and Prescriber Insights subscribers, to help guide decision-making and prevent dispensing mishaps if you see prescriptions in the pharmacy.
00:29:16 Steve Small
Yeah, great.
00:29:17 Steve Small
And with that, let’s make like a hair and fall to our last segment here.
00:29:21 Steve Small
It’s time for the Rumor vs Truth mailbag.
00:29:25 Steve Small
We have an audience question from the last episode about menopause treatments that came in through our [email protected] e-mail address.
00:29:33 Don Weinberger
All right, so our last episode was dispelling myths and applying facts about menopause treatments, right?
00:29:39 Don Weinberger
So, this question did ask, does black cohosh increase estrogen levels?
00:29:46 Steve Small
Well, can we get Jeff back in here?
00:29:50 Don Weinberger
He’s probably long gone.
00:29:51 Steve Small
He’s already out the door.
00:29:53 Steve Small
Thankfully, we did some of the homework on our own.
00:29:55 Steve Small
And we looked this up in our NatMed Pro database.
00:29:58 Steve Small
And research on black cohosh shows mixed results.
00:30:01 Steve Small
A large review of 22 studies found that taking black cohosh from anywhere from 4 to 52 weeks can modestly improve overall menopausal symptoms, especially hot flashes and other physical complaints.
00:30:13 Steve Small
But it didn’t show clear benefits for things like mood symptoms, things like anxiety or depression.
00:30:19 Steve Small
And an analysis of 20 clinical trials found that black cohosh isn’t consistently better than a placebo and is less effective than hormone therapy for reducing hot flashes.
00:30:29 Steve Small
So interesting pieces there.
00:30:30 Don Weinberger
Yeah, that is interesting.
00:30:32 Don Weinberger
Something to piggyback off that is, what’s the idea of kind of how black cohosh works then?
00:30:38 Steve Small
Yeah, that’s a really good question.
00:30:40 Steve Small
And its mechanism isn’t really clearly understood at this point, but it seems to act more like a selective estrogen receptor modulator or SERM.
00:30:48 Steve Small
By decreasing menopausal symptoms without increasing circulating estradiol levels.
00:30:53 Don Weinberger
Interesting. So the next question is going to be any side effects with that?
00:30:58 Steve Small
Yeah, you could say yes, SERM.
00:31:00 Steve Small
Some common ones include breast tenderness, headache, and irritability, much like what you’d see from a prescription SERM like raloxifene.
00:31:08 Steve Small
So overall, black cohosh may help some physical symptoms of menopause but it doesn’t seem to reliably improve mood and it doesn’t out-perform hormone therapy.
00:31:18 Steve Small
So really important to keep in mind.
00:31:19 Don Weinberger
Great for elaborating and glad we were to press play on that menopause question.
00:31:25 Don Weinberger
So to our audience, don’t brush off your burning questions.
00:31:28 Don Weinberger
Please send them in, and we will tackle them next month about hair loss.
00:31:32 Steve Small
Yeah, and we also use your suggestions to plan our episodes.
00:31:35 Steve Small
So e-mail us at [email protected] or send us a text right from the podcast show notes.
00:31:41 Don Weinberger
Right, before you go, claim CE credit and access evidence-based resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights.
00:31:49 Steve Small
And if you’re not yet a subscriber or just want to upgrade, you can save 10% with our exclusive listener code, RVT1026 at checkout.
00:31:57 Steve Small
And there’s an easy link in the show notes.
00:31:59 Don Weinberger
And are you a subscriber?
00:32:00 Don Weinberger
Tap the claim credit link in the show notes or search your CE organizer for this episode.
00:32:06 Steve Small
Yeah, definitely get that CE credit.
00:32:08 Steve Small
And join us next time where we’ll talk about artificial intelligence in practice.
00:32:12 Don Weinberger
Sounds like fun.
00:32:13 Don Weinberger
So, thanks again for joining us on Rumor vs. Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.
00:32:21 Don Weinberger
See you next time.
Rumor vs Truth
