What’s The Best Shampoo To Reverse Hair Loss?

Dr. Melissa Toyos is an oculofacial surgeon specializing in FUE (follicular unit extraction) hair and eyebrow transplantation, CO2 facial resurfacing, and sculpting faces with injectables. A summa cum laude graduate and board-certified Ophthalmologist, she is a partner at Toyos Clinic and formerly was a partner at one of the largest eye care practices in the country. Dr. Toyos is a national researcher and lecturer. She trains other doctors on surgical techniques as well as cosmetic procedures. Her clinical research has been instrumental in many FDA approvals. She is the former President of the Missouri Society of Eye Physicians and Surgeons. She has held various leadership positions with the AAO. Dr. Toyos has served as a mentor to young female surgeons, helping them understand how to balance a career and motherhood. 

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Haute Beauty expert Dr. Melissa Toyos is a hair and eyebrow transplant surgeon and in general, doesn't always recommend shampoos for hair loss. What she DOES recommend is that people spend their money on other products: Olaplex, hair color, and prescription-strength medications that will definitely make a difference in the health, growth, and texture of hair. The reason? Shampoo stays on the hair and scalp for such a short time, that no matter what ingredients are in there, you aren’t going to get much contact time or potential for benefit, and it doesn’t touch the root cause of hair loss – the follicle – which is underneath the scalp.

But ketoconazole shampoos are different. Dr. Toyos has been prescribing them more and more since she started the great COVID hair loss experiment of 2020. Ketoconazole is known as an anti-fungal agent but has been used successfully for decades to combat hair loss related to age, genetics and stress. It is available over the counter at a weaker strength in a product called Nizoral but the stronger prescription-strength concentrations work better for hair loss. As an expert, Dr. Toyos dives into how ketoconazole shampoos can help you to reverse hair loss. Here's what she had to say:

How it works

Ketoconazole calms inflamed scalps suffering from seborrheic dermatitis or dandruff but the key to its hair loss activity is that it reduces the amount of DHT or dihydrotestosterone on the surface of the scalp that triggers miniaturization and loss of hair follicles in both men and women. The amount of DHT you create is important but your sensitivity to those receptors in your scalp (which can be genetic) primarily determines how much impact the DHT has on your hair loss. Ketoconazole is an ingredient that can mitigate the damage when used as directed especially when I compound it with additional agents to reduce inflammation.

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I recommend that my patients use ketoconazole shampoo twice-weekly (you want to avoid over-washing which can strip hair of necessary oils) and leave it on for at least 5 minutes. For many that means, using the shampoo first in the shower and then rinsing it at the end of your shower. Some men put it on and grab their first cup of coffee while they are waiting or watching a few minutes of Netflix. It is typical to see results within 3 months of usage.


I don’t see many side effects from ketoconazole shampoo but some people can be sensitive to it and experience a rash or hives, minor scalp irritation or dryness. Ketoconazole shampoo is definitely not the first treatment I reach for with hair loss and it typically isn’t the second either. But when patients are doing everything and still want more results, it has been an important part of a healthy hair growth regimen for my patients. If you would like to learn more about hair loss and treatments that might be right for you, call or consult with Toyos Clinic Hair Restoration today at 800.901.6638.

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