An In Depth Look At Ketoconazole For Hair Loss: Does It Work?

Updated: Jul 9, 2020

Ask yourself this question: when you are shopping for shampoo what matters most to you? Is it that you will have great smelling hair? What about hair that feels great after your shower? The truth is… keeping your hair in your head should be your number one concern.

Okay that was a little dramatic, but there are a lot of shampoos that contain chemicals that can severely damage your hair. Yeah they might make your hair feel and smell good in the short term, but they are terrible for your hair in the long term, especially if you are suffering from male/female androgenic alopecia (pattern hair loss).

For those who are experiencing hair loss, finding the right shampoo can make a world of difference, and may even determine whether or not your hair loss regimen works entirely. You should always be reading the ingredients on your shampoo bottle and making sure you know which ones to avoid. Among the most harmful ingredients are: parabens, fragrances, propylene glycol, and sodium chloride, but there are many more you should watch out for (full list here).

Ideally, someone who is suffering from androgenic alopecia should be using a hair loss friendly shampoo (usually not sold at big retail stores). Not only do they not include many of the harmful ingredients, but they (should) include a key ingredient called ketoconazole.

Ketoconazole is powerful ingredient that has been shown to help combat hair loss in multiple ways. Let’s take a deeper dive into ketoconazole and find out why you need to start using it if you are suffering from hair loss.

What is ketoconazole?

Ketoconazole was patented in 1977 as an antifungal medication, and went into medical use in 1981. Essentially what it does is kills and prevents further growth of fungus and yeast. Its antifungal properties make it an effective remedy for conditions such as: athletes foot, ringworm, seborrheic dermatitis, and most importantly dandruff. It is used solely for skin conditions and can cause irritation and other issues if it gets in your eyes, mouth, or enters your body elsewhere.

It is commonly sold as a shampoo under the brand name Nizoral. Nizoral contains 1% ketoconazole (to buy 2% you need a prescription) and is marketed as an “anti-dandruff” shampoo, but the implications go far beyond that.

Ketoconazoles benefits for hair loss

Ketoconazole shampoo is often referred to as one of “the big three” when it comes to hair loss treatments alongside finasteride and minoxidil. This is because its antifungal properties help to reduce microflora (fungus, bacteria, etc.) in the scalp. Why is this important? Because it helps prevent dandruff and seborrheic dermatitis.

Dandruff is caused by a fungus called malassezia, and seborrheic dermatitis is exacerbated by yeast. Both conditions have been shown to cause oxidative stress which leads to aging (thinning) of the hair follicles. Dandruff is also known to cause inflammation which has been linked to hair loss. By reducing and preventing these conditions, ketoconazole may be indirectly helping reduce hair loss. In fact, one study compared ketoconazole to minoxidil and found that both treatments worked equally well in increasing the size and proportion of anagen hair follicles (hair in the growth stage).

If there were several more studies like this, the evidence would be undeniable for ketoconazole’s hair loss benefits, but there aren’t. Though that study is promising, minoxidil has much more data to support it, which is why you should neverreplace minoxidil, or any hair loss treatment for that matter, with ketoconazole. One study even showed that ketoconazole worked best when it was used alongside finasteride and minoxidil. But ketoconazole, although promising and praised by its users, should not be used as a standalone hair loss treatment, at least until there is more data available.

What ketoconazole cannot do

Ketoconazole does not block DHT, and don’t believe anyone that says it does.

DHT is the hormone that is mainly responsible for androgenic alopecia and has been the target or scientific research for many years. Drugs like finasteride and dutasteride, amongst others, have been approved by the FDA for blocking DHT and have shown to be up to 99% effective. Ketoconazole? Well the research just isn’t there.

Although one study showed that ketoconazole may disrupt the DHT pathway, using it for that purpose would be a lot like taking a shot in the dark: you probably won’t hit your target.

Ketoconazole will also not regrow lost hair. Any hair that has fallen out as a result of miniaturization (the “slow death” of the hair follicle caused by DHT) is likely gone forever. If you use ketoconazole in conjunction with finasteride, you may be able to nurture your vellus hair (small, thin hair where your healthy hair used to be) back to life, but there is no scientific evidence to back that, so don’t bank on it.

A suggestion from someone who overcame hair loss

Having overcome hair loss myself after battling it for seven years, I have a suggestion that worked for me and will likely work for you as well. Although it may seem obvious, use a ketoconazole shampoo with, at bare minimum, finasteride and minoxidil, although I highly suggest you use several other effective treatments (more on those here). All of these treatments attack hair loss in different ways and help boost the effectiveness of one another, and if you don’t respond to one? You’ve got all your bases covered.

Having used Nizoral in the past, I can tell you right now that there are much better options available. My personal favorite and the shampoo I use to this day is Lipogaine. Nizoral is more specifically targeted towards dandruff, whereas Lipogaine contains several ingredients such as caffeine, emu oil, and more than have benefits for hair loss (this is not an ad I just love the stuff).

In conclusion

Ketoconazole does not have enough evidence supporting it as a standalone hair loss treatment. But this doesn’t mean that you shouldn’t add it to your hair loss regimen. The limited data we have is promising and shows that ketoconazole might be effective when used alongside other treatments. Acting as an antifungal, ketoconazole helps prevent scalp issues such as dandruff and seborrheic dermatitis, which has implications for indirectly benefiting hair loss.

All in all ketoconazole has lots of potential upsides and little downside. It’s relatively cheap and may prove to be a valuable boost to your hair loss regimen.