Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 6/3/2021
If you’ve ever searched for information about over-the-counter treatments for hair loss, you may have heard of ketoconazole.
Ketoconazole is an antifungal medicine that’s used to treat skin infections. In addition to treating fungal infections, some research has found that ketoconazole may help to treat hair loss caused by male pattern baldness.
Researchers believe that ketoconazole may do this by affecting DHT, the hormone responsible for hair loss in men.
While ketoconazole is a safe and useful addition to a hair loss prevention routine, it’s also not a miracle hair loss cure.
Like many non-prescription hair loss treatments, there are lots of myths and rumors about what ketoconazole can and can’t do for your hair health.
Below, we’ve listed some of the most common myths about ketoconazole as a non-prescription treatment for hair loss.
We’ve also shared the most recent scientific evidence on ketoconazole to explain what it can do for your hair, as well as how you can fit it into your routine to treating male pattern baldness.
Ketoconazole is an antifungal medication. It’s available in tablet and cream form and is used to treat many common fungal infections, including tinea corporis (also known as ringworm), tinea cruris (jock itch) and tinea pedis (athlete’s foot).
Currently, ketoconazole is rarely used as a first-line treatment for fungal infections.
Instead, it’s usually only prescribed when newer, more effective antifungal treatments can’t be used due to lack of availability or side effects.
Some shampoos designed to treat fungal scalp infections, such as scalp ringworm, also contain ketoconazole as an active ingredient.
Ketoconazole shampoos are often marketed as treatment for seborrheic dermatitis and dandruff caused by a dry scalp. One common brand of ketoconazole shampoo is Nizoral®.
If you’ve ever spent time on discussion boards or blogs that deal with men’s hair loss, you may have seen ketoconazole shampoo recommended as one of the “big three” hair loss treatments, alongside the medications minoxidil and finasteride.
Proponents of ketoconazole shampoo believe that it can disrupt the effects of DHT, a hormone produced as a byproduct of testosterone that causes male pattern baldness.
If you’re genetically predisposed to male pattern baldness, DHT can attach to receptors in your scalp and, over time, damage your hair follicles.
Our guide to DHT and male pattern baldness discusses this process and its effects on your hair in more detail.
Research on the relationship between ketoconazole and male pattern baldness is largely mixed, although some studies have found that ketoconazole may help to prevent hair loss.
For example, a systematic review published in the journal Dermatologic Therapy found that use of topical ketoconazole can increase the diameter of the hair shaft (the physical part of hair that grows out from the hair follicle).
The same review noted that one study found that ketoconazole can increase the pilary index, a measure of the percentage of hairs in the anagen (growth) phase of the hair cycle multiplied by the hair shaft diameter.
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One of the more common myths about ketoconazole is that it’s just as effective at treating and preventing hair loss than FDA-approved hair loss medications such as minoxidil.
The truth is that while ketoconazole does appear to have some positive effects on hair growth, there’s only a small fraction as much research into the effects of ketoconazole on hair as there is for minoxidil.
This myth appears to stem from a single study that was published in the journal Dermatology in the late 1990s.
In this study, researchers compared the effectiveness of a 2% ketoconazole shampoo with the popular hair loss medication minoxidil.
They found that both treatments improved hair size and the proportion of hairs in the anagen (growth) phase by a similar amount.
While the findings of this study are interesting, it’s important to note that the researchers noted that the clinical significance “awaits further controlled study in a larger group of subjects.”
In simple terms, more research is needed before it’s possible to make any serious conclusions about the effectiveness of ketoconazole in comparison to minoxidil.
Despite this study’s relatively small size, it’s certainly interesting to see that ketoconazole had such a noticeable effect on the hair growth cycle.
If you want to improve your hair growth, a ketoconazole shampoo could be a good addition to your hair health stack.
Just don’t assume that it’s more effective on its own than minoxidil, as there just isn’t enough data to support that conclusion right now.
Another common ketoconazole myth, as we mentioned earlier, is that it blocks the conversion of testosterone to dihydrotestosterone, or DHT -- the male hormone that damages hair follicles and causes male pattern baldness.
Currently, there’s very little scientific research on the link between ketoconazole and DHT levels.
One paper published in the journal Medical Hypotheses theorized that ketoconazole may help to disrupt the DHT pathway in the scalp, which could have an effect on DHT-related hair loss.
However, there are no large-scale studies showing that ketoconazole causes any real reduction in DHT levels in the scalp or throughout the body.
This means that you shouldn’t rely on ketoconazole shampoo as a potential DHT blocker.
If your hairline is starting to recede and you’d like to lower your DHT levels, you’ll get better results with a science-based treatment such as finasteride.
Another common myth about ketoconazole shampoo is that it can cause you to regrow the hair that you’re already lost due to male pattern baldness.
Like most myths, this one has an ounce of truth to it.
While ketoconazole can’t regrow hair that has fallen out as a result of male pattern baldness, it may potentially help you regrow hair that’s temporarily fallen out due to seborrheic dermatitis.
Seborrheic dermatitis is a scalp condition that can cause temporary hair loss.
Some research has found that Malassezia -- a type of fungi that contributes to seborrheic dermatitis -- is linked to hair shedding.
This type of hair loss isn’t caused by genetics or the effects of DHT, and is largely unrelated to male pattern baldness.
Since ketoconazole is an effective treatment for seborrheic dermatitis, it’s easy to mistake the hair you may regrow after successfully treating seborrheic dermatitis as "permanent" hair loss that’s reversed because of ketoconazole.
The unfortunate truth is that any hair you’ve lost due to male pattern baldness is, for the most part, gone for good unless you treat it very quickly using medication.
Beyond this, the only proven way to "regrow" patches of permanently lost hair is through hair transplant surgery.
Finally, one annoyingly common myth about ketoconazole is that it’s the only product you need to use to stop hair loss.
This one is easy to understand. After all, who wouldn’t rather just use a daily shampoo than take a pill and apply a hair growth serum or foam?
Unfortunately, while ketoconazole might be effective in treating hair loss and increasing the rate at which you grow new anagen hairs, there’s no proof that it’s an effective hair loss treatment on par with FDA-approved medications like finasteride.
If you’re suffering from severe hair loss caused by male pattern baldness, ketoconazole usually won’t be enough to stop it on its own.
This is particularly true if you have hair that’s highly sensitive to DHT and noticeable, worsening hair loss.
To stop male pattern baldness, you need to dramatically reduce your levels of DHT. This means that you can’t use ketoconazole on its own with any likelihood of success.
Currently, most research shows that the most effective treatment for male pattern baldness is a combination of finasteride and minoxidil.
These treatments are both supported by large amounts of scientific research, as well as millions of successful users around the world.
They’re also both approved by the FDA as treatments for androgenetic alopecia, or male pattern baldness.
While there’s no real harm in using ketoconazole shampoo, especially one that you can buy over the counter, it’s important not to rely on it as a replacement for hair loss medications like finasteride and minoxidil.
We offer both of these medications together in our Hair Power Pack, which is available after a consultation with a licensed healthcare provider.
Instead of relying on ketoconazole shampoo alone, take the “big three” approach and use it at the same time as finasteride and minoxidil.
Not only will this target your hair loss from several angles -- it may also help if you’re prone to skin conditions such as seborrheic dermatitis or scalp fungus, both of which can improve with the use of ketoconazole shampoo.