Hair growth is a crowded category, but the treatments with the strongest science behind them are still relatively few. Minoxidil and finasteride remain two of the most established options, while peptides and growth factors are emerging as newer ways to support the hair cycle.

We asked board-certified dermatologist Amy Forman Taub, MD, FAAD, and clinical researcher for KeraFactor, to break down what actually works, who each treatment is best for, and where newer scalp-focused formulas fit in.

Hair growth has become such a crowded category. When a patient comes to you concerned about thinning or shedding, how do you determine what is actually causing it before recommending a treatment?

This is a very complicated question. It is best diagnosed by your dermatologist. But in very simplistic terms the most common causes are androgenetic alopecia and telogen effluvium. The former is classic male and female pattern hair loss, onset is gradual. Males have a receding hairline at the front and temples and loss of hair on the crown, and females traditionally have hair loss on the top of their head and crown, but can have frontal or temporal loss too. Telogen is more sudden shedding and is not in a pattern, but is diffuse. There can be combos. There is also a whole list of scarring and inflammatory hair loss that has different findings. 

When we talk about the “best” hair growth treatments, which options currently have the strongest evidence behind them, and how do you decide which treatment is right for which patient?

Most hair loss treatments are typically focused on androgenetic alopecia. The ones with the best literature are minoxidil and finasteride, but this hasn’t changed for many years. There is some good evidence that platelet rich plasma is helpful, but it is hindered by pain with injection, the need to remove and prepare blood properly to get the plasma, and inconsistent quality due to donor health and age.  There is some emerging data that certain combinations of growth factors and other peptides can stimulate hair regrowth, and these can be manufactured biomimetically so that the dosage can be controlled in a finished product. 

What is the difference between topical and oral minoxidil when it comes to effectiveness, side effects and who is a good candidate for each?

Compliance is a big issue with topical minoxidil. Applying a serum that can be oily and/or messy every day can be a challenge for many. Many women, particularly, don’t shampoo every day. It is easier to take a pill daily. There appears to be no difference between the two in terms of effectiveness. 

Finasteride, commonly known by the brand name Propecia, is another established treatment for male pattern hair loss. How does it work differently from minoxidil, and who is the best candidate for it?

Finasteride blocks dihydrotestosterone, the molecule responsible for the miniaturization of hairs, ultimately leading to the hair’s disappearance. This is not the only factor causing hair loss, as it is quite complex. Minoxidil increases some growth factors that resist the miniaturization of hairs. Finasteride cannot be taken by women of childbearing years due to a potential for causing testosterone blockage in a developing fetus.

Can minoxidil and finasteride be used together, and is combination therapy generally more effective than using either treatment alone? and is it true that once you start minoxidi or finasteridel, you essentially have to continue using it to maintain the results? What typically happens when someone stops?

Yes they can be taken together and there is evidence that they work better than either alone, since they work on different aspects of hair growth. If one stops using either of these, the effects of the stimulation and/or blockage are not maintained and there will be a gradual return to the hair loss which may seem worse than before but isn’t- a person with return or the baseline they would have been at their current age and not at the age they started treatment. 

Where do newer approaches like peptides and growth factors fit alongside minoxidil and finasteride? Are they alternatives, complementary treatments or targeting entirely different aspects of hair growth?

Growth factors and peptides are more aligned with minoxidil and prp as they work to stimulate all phases of hair growth. There are 4 stages of hair growth and a serum can be made it include the factors that affect all four. Minoxidil effect is dependent on a persons ability to change it internally into another chemical that is the actual effector – many people do not have a sufficient amount of that enzyme so the results can be variable. Women have a variable response to finasteride- they need a higher dose than men and can only take if menopausal. Spironolactone is another hormonal based treatment for females but the data is not robust.

Your work with KeraFactor grew out of a more scalp-first approach to hair rejuvenation. What did you feel was missing from the traditional hair growth category when the brand was being developed?

We knew that growth factors were effective for hair growth due to the success of PRP, but wanted to have a product that would address all stages of growth and not have an issue with variability in quantity or quality, not to mention being practical since it is off the shelf. Many people wanted to avoid the potential side effects of hormonal or other therapy or they weren’t seeing enough results. 

KeraFactor uses biomimetic growth factors and peptides. Which growth factors and peptides are central to the formula, and what role is each one intended to play in supporting the scalp and hair follicle?

This could be a very long and scientific answer. While I can’t go over every single ingredient, I will highlight a few: VEGF stimulates blood vessels around the follicle which is essential to deliver nutrients, EGF helps the hair shaft grow and develop its structure and the latter is missing from PRP as platelets are focused on healing and there is some overlap but not 100%. FGF stimulates the mature hair cycle to be turned on from resting phases.

What clinical research or testing has been done on the KeraFactor formulations, and what results have been most meaningful to you as a dermatologist?

One study has been published definitively showing that a 1927 laser paired with KeraFactor serum was better than laser alone when performed  monthly for 3 times.  An upcoming study has been completed in Europe, and we are awaiting publication, but the results are not yet available. It is also meaningful to me to hear from my patients consistently that KeraFactor has helped their hair growth whether just topically or with microneedling or laser. I personally have found the take home products very effective for improving my hair quality and density.