Hair Supplements: Combing Through the Pros, Cons, and Cautions

Hair loss is a frequent concern that brings people to the dermatology office, and many patients seek out nutritional supplements to mitigate thinning hair and promote regrowth.

There are challenges in advising patients about nutritional supplements for hair loss, including a lack of rigorous scientific evidence behind most, if not all, of the hair supplements, as well as the multifactorial etiologies of hair loss, and the attendant risk of missing something serious if a patient goes straight to a hair supplement without a thorough analysis by a dermatologist.

“In general, I find supplements can be a reasonable addition to regimens, but rarely suggest them alone and always give the pros and cons of whether they may be useful,” Joel E. Schlessinger, MD, a dermatologist in private practice in Omaha, Nebraska, told Modern Aesthetics® in an interview. “The other big issue is expectations. Most patients assume that hair growth will magically occur within days or weeks, but it is always a long-term issue, as we all know, and quite a bit of work is needed to set a reasonable timeframe.”

For patients seeking nutritional supplements for hair loss who might derive some benefit from them, Dr. Schlessinger discussed the range of products available, including the products available in his office, explaining that no one product is going to do the entire job in most people.

“Most of these individuals who present to dermatology practices will invariably start on some form of over-the-counter product, and it is incumbent to give patients options that we, as dermatologists, recommend,” he said. “We carry a variety of options in our practice, and there is a wealth of other products available to them from other sources. I always let them know it isn’t a guarantee that they will work.”

Potential Pitfalls

Dr. Schlessinger cautioned that while there are positives from these products, there are also a myriad of ways supplement use can go wrong. “They can lead to allergic reactions if they contain unreported additives,” he warned. “We all have heard of situations where liver or other damage is sustained during the seemingly innocuous intake of supplements, so it is important to find a manufacturer that you can trust. This is often a leap of faith, though.”

One of the chief barriers patients face when they decide to take hair supplements is the cost.

“Supplements can be quite expensive, sometimes marked up by hundreds, if not thousands of percentage points over cost, and it pains me to see people wasting money on products not supported by solid evidence,” Dr. Schlessinger said.

“We offer a variety of supplements in our office, and many have fairly decent studies behind their usage.”

Although some supplements have been studied in clinical trials, data on their use for hair loss are often lacking, especially when compared to the trials of supplements for sun prevention and acne.

“Many nutritional supplements for hair loss simply offer a modest or minimal benefit,” he said. “The reality is that we live in a world where patients will find these supplements one way or another, through dermatologists, other health professionals, or even unscrupulous infomercials, and when it comes to skin, hair, and nail health, dermatologists are most qualified to proffer advice.”

On Supplements and Clinical Research

The question of research into the safety and efficacy of nutritional supplements for hair loss is a tough one, according to Dr. Schlessinger. One of the issues is that any research done on the supplements or products that intends to show a benefit may cause the supplement to be viewed as a drug, causing it to rub up against different regulatory regimes than those governing supplements. “This could lead the FDA to insist on a new drug application, so it is incumbent on the manufacturer to be careful in what they show via trials or claims/promotion of the product,” he explained. “It is mind-boggling to see the overreach of many supplement products with claims to help memory, sexual dysfunction, or other medical issues. These products continue to be sold and promoted with no apparent restrictions, but we often see actions by the FDA for minor infractions by pharmaceutical companies that do their best to toe the line.”

In a recent systematic review published in JAMA Dermatology, a research team at Tufts University analyzed 30 studies involving dietary and nutritional interventions in patients with alopecia or hair loss and no known nutritional deficiency.¹

Overall, the nutritional supplements with the strongest evidence for efficacy have been branded products: Viviscal, Nourkrin, Nutrafol, Lambdapil, and Pantogar. Other supplements that showed effectiveness included a combination of capsaicin and isoflavone, apple , omega-3 and omega-6 fatty acids with antioxidants, zinc, tocotrienol, and pumpkin seed oil.

Additionally, total glucosides of paeony (TGPC) and compound glycyrrhizin tablets (CGT) demonstrated high-quality effectiveness based on randomized, controlled trials. TGPC, CGT, and Chinese herbal plant extracts have shown an ability to regulate T-cell activation, and previous research suggests that immunomodulators might affect hair regrowth in autoimmune conditions such as alopecia areata, according to the authors of the analysis.

Popular supplements with low quality of evidence to improve hair loss included kimchi and cheonggukjang, vitamin D₃, and Forti5 (a supplement containing antioxidants, melatonin, cholecalciferol, soy phytoestrogens, and botanical 5-alpha reductase inhibitors).

The review was limited by nonstandardized inclusion criteria, definitions of hair loss, and outcomes assessments, which limited comparisons between studies and generalizability to all individuals with hair loss, its authors noted. The funding of some studies by the manufacturers also introduced potential bias. Although the studies in the review showed few adverse events associated with any of the supplements examined, and the data suggest that some patients with hair loss may benefit from supplements, the researchers remained adamant that patients and clinicians should remain aware of the lack of FDA oversight on safety and effectiveness of these products when considering their use.

“More research is needed in the form of randomized controlled trials to assess safety and effectiveness, including studies of nutritional supplements as adjunct or alternative treatments to the FDA-approved finasteride and minoxidil for alopecia,” they wrote.

Patient Selection for Success

According to Jeanine Downie, MD, a dermatologic surgeon in private practice in Montclair, New Jersey, the main challenge in advising patients who want to take nutritional supplements for their hair is the desired timeframe and associated expectations, echoing the issues highlighted by Dr. Schlessinger.

“Patients must be consistent and take the nutritional supplement for a minimum of six months to a year before they see a significant difference,” she said in an interview. “Unfortunately, in this immediate gratification world, patients want immediate gratification with their hair, and that is not reality.”

She added that patients with poor hair-care practices, such as putting too much heat on their hair or over-perming, over-coloring, or straightening their hair, should cease engaging in these practices to improve their health.

“The subset of patients who will genuinely improve from using nutritional supplements for the hair include those who have noticed subtle changes in their hair as they start aging and want to do something about it immediately, and are committed to a plan of action,” Dr. Downie shared. “That being said, nutritional supplements will help everyone to some extent, but commitment is key, and ensuring that patients consistently take the nutritional supplement daily as recommended is critical for success.”

The primary risks from nutritional supplements for hair tend to be allergy/allergic reaction to the ingredients in the supplement, but the risk is generally low. For some people, any nutritional supplement can cause heartburn. Dr. Downie shared some recommendations and advice for commonly used supplements.

“I strongly recommend Nutrafol to the majority of my patients who come in seeking a nutritional supplement,” Dr. Downie said. “Nutrafol has clinical studies behind it showing that it can help with hair growth in many patients. For hair growth in general, I like rebooting with the DefenAge 150K Hair Follicle Serum, and I recommend that once a year to my patients for three months, as well as ISDIN’s Lambdapil shampoo and spray, which I recommend once to twice a week for the majority of my patients.” Perhaps unsurprisingly, Dr. Downie also believes more clinical trials are needed on hair health with nutritional supplements in general, particularly including participants from all races/ethnicities and hair types. —by Heidi Splete

Disclosures: Dr. Schlessinger disclosed selling supplements in his office and online via his practice website, lovelyskin.com.

Dr. Downie disclosed serving as a consultant and lecturer for Nutrafol, ISDIN, and DefenAge.

The cited study received no outside funding; several researchers disclosed relationships with multiple companies outside the submitted study, including Concert, Pfizer, Lilly, AbbVie, and Bioniz.

1. Drake L et al. Evaluation of the Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss: A Systematic Review. JAMA Dermatol. 2023;159(1):79-86. doi:10.1001/jamadermatol.2022.4867. Published online November 30, 2022